# Pulmonary endarterectomy in antiphospholipid syndrome: a retrospective analysis from the Saudi pulmonary hypertension registry

## TL;DR

This study examines the outcomes of pulmonary endarterectomy in patients with antiphospholipid syndrome and chronic thromboembolic pulmonary hypertension.

## Contribution

The study provides insights into postoperative complications and persistent PH in APS-CTEPH patients compared to non-APS patients.

## Key findings

- APS-CTEPH patients had higher postoperative complications but similar persistent PH rates.
- Pulmonary vasodilator therapy before surgery reduced the risk of persistent PH in APS-CTEPH patients.
- Five-year survival rates were high and similar between APS and non-APS groups.

## Abstract

Antiphospholipid syndrome (APS) is associated with venous thromboembolism, which can lead to chronic thromboembolic pulmonary hypertension (CTEPH). Despite treatment with pulmonary endarterectomy (PEA), some patients continue to experience pulmonary hypertension (PH), which is potentially caused by APS-related distal vasculopathy. The aim of this study was to assess persistent PH after surgery and to investigate post PEA outcomes, including immediate postoperative complications, hospitalizations within 1 year of surgery, and mortality.

We performed a retrospective analysis of adult patients with CTEPH who underwent PEA. We included patients with and without APS. Data were obtained from the Saudi Pulmonary Hypertension Registry (2011–2022). We assessed immediate postoperative complications, rehospitalizations within 1 year, and mortality. Additionally, we evaluated patients with right heart catheterization 1 year before and after PEA for persistent PH.

The study included 37 patients with APS-CTEPH and 41 patients without APS. Persistent PH was observed in 43% of patients, with no significant difference between the groups. Notably, patients in the APS-CTEPH group who received pulmonary vasodilator therapy before PEA had a reduced risk of developing persistent PH. Postoperative complications were significantly higher in the APS-CTEPH group (p = 0.002). Despite these risks, the 5-year survival rate was 98.3%, with no significant difference between the groups.

APS is associated with a higher incidence of immediate postoperative complications and rehospitalizations within the 1st year after surgery. However, APS does not appear to increase the risk of persistent PH or affect long-term mortality in this cohort.

Retrospective study from 2011 to 2022 on PEA outcomes in APS-CTEPH. Seventy-four patients were analyzed: thirty-seven with APS, forty-one without. Post-surgery outcomes included: 90% thrombocytopenia, 16% AKI with hyponatremia, 16% stroke/seizures/confusion, 10% arrhythmia/pericardial effusion. APS group showed a 50% increased risk of complications and 43% developed persistent PH. Five-year survival rate was 98.3% in both groups.