Larger pulmonary artery to ascending aorta ratios are associated with decreased survival of patients undergoing pulmonary endarterectomyCentral MessagePerspective
Panja M. Boehm, MD,
Stefan Schwarz, MD,
Jürgen Thanner, MD,
Cecilia Veraar, MD,
Mario Gerges, MD,
Christian Gerges, MD,
Irene Lang, MD,
Paul Apfaltrer, MD,
Helmut Prosch, MD,
Shahrokh Taghavi, MD,
Walter Klepetko, MD,
Hendrik Jan Ankersmit, MD, PhD,
Bernhard Moser, MD, PhD, MBA
Affiliations
Panja M. Boehm, MD
Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
Stefan Schwarz, MD
Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
Jürgen Thanner, MD
Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
Cecilia Veraar, MD
Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
Mario Gerges, MD
Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
Christian Gerges, MD
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
Irene Lang, MD
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
Paul Apfaltrer, MD
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
Helmut Prosch, MD
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
Shahrokh Taghavi, MD
Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
Walter Klepetko, MD
Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
Hendrik Jan Ankersmit, MD, PhD
Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
Bernhard Moser, MD, PhD, MBA
Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria; Address for reprints: Bernhard Moser, MD, PhD, MBA, Department of Thoracic Surgery, Medical University of Vienna, Austria, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Objectives: The ratio of pulmonary artery (PA) and ascending aorta (AA) diameters has recently been shown to be a useful indicator for disease severity and predictor of outcome in patients with pulmonary hypertension and heart failure. This study aimed at evaluating the applicability of this ratio for perioperative risk assessment of patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy. Methods: In this retrospective cohort study on 149 patients undergoing pulmonary endarterectomy between 2013 and 2020, the preoperative PA to AA ratio was analyzed on axial computed tomography. Variables of pulmonary hemodynamic status were assessed during preoperative right heart catheterization and postoperative Swan-Ganz catheter measurements. Perioperative survival was analyzed by Kaplan-Meier method and log-rank tests. Results: Preoperative computed tomography measurements showed a median AA diameter of 31 mm (range, 19-47 mm), and a median PA diameter of 36 mm (range, 25-55 mm). The calculated median PA to AA ratio was 1.13 (range, 0.79-1.80). PA to AA ratio correlated positively with PA pressure (systolic, r = 0.352 [P 1.136; survival probability, 88.9%). Conclusions: PA to AA ratio shows a correlation with other variables associated with pulmonary hypertension. In addition, patients with higher PA to AA ratios have lower survival probabilities after PEA. Further analysis of PA to AA ratio on the selection of chronic thromboembolic pulmonary hypertension for different treatment modalities—pulmonary endarterectomy, medical therapy, and or balloon pulmonary angioplasty—is warranted.
