Residual Pulmonary Hypertension After PEA Operation Risk Factors Analysis And Logistic Regression Model Development

Chronic thromboembolic pulmonary hypertension(CTEPH)and primary pulmonary artery sarcoma(PAS)are the Group 4 obstructive pulmonary hypertension.Pulmonary endarterectomy(PEA)is an effective treatment for CTEPH,recommended by the current guidelines.Residual pulmonary hypertension(RPH)after the PEA operation is an essential factor affecting CTEPH patients' prognosis.There are few prognostic models for CTEPH patients treated with PEA in guidelines and works of literature.In this study,we established a logistic regression model to predict the outcome of RPH after PEA in CTEPH patients.PAS is a rare macrovascular malignant tumor,and its surgical diagnosis,treatment,and prognosis information are of great reference value in this field.From July 2018 to January 2021,83 patients,including 77 CTEPH and six PAS in the Department of cardiovascular surgery of China-Japan Friendship Hospital,were collected.The mean pulmonary artery pressure(mPAP)?25mmHg and pulmonary capillary wedged pressure(PCWP)?15mmHg measured by right heart catheterization(RHC)24 hours post-PEA was defined as RPH as the outcome event.A logistic regression model was established to predict the occurrence probability of RPH after PEA.The clinical data of 6 patients with PAS were summarized.English and Chinese literature with at least 5 case reports published by January 2021 were included.A total of 201 patients with PAS were collected,and 158 patients' data included specific treatment and prognosis follow-up information.The RHP logistic regression model included age,surgical time,WHO Function Classification(WHO-FC),6 minutes walking distance(6MWD),and serum uric acid.The likelihood ratio test(LRT)showed that the P-value with P<0.05 had WHO-FC,6MWD,and serum uric acid.The odds ratio(OR)and 95%confidence interval(95%CI)and Wald test results of medium risk of WHO-FC,medium risk of 6MWD and serum uric acid are 10.35(3.26-32.85),P=0.007,5.48(1.79-16.79),P=0.046,1.0069(1.0028-1.0112),P=0.004,respectively.All 6 PAS patients had mPAP<25mmHg after PEA,four patietns received regular adjuvant chemotherapy post-PEA.As of January 2021,5 patients were still alive(15-35 months),and one patient suffered from tumor recurrence was lost to follow-up ten months after the operation.WHO-FC,6MWD,and serum uric acid can effectively predict RPH incidence after the PEA operation in CTEPH patients.In addition to the WHO-FC,6MWD,NT-proBNP,right atrial pressure(RAP),cardiac index(CI),and mixed oxygen saturation(SvO2)included in the risk stratification criteria for adult pulmonary hypertension recommended by domestic and European guidelines for the treatment of pulmonary hypertension,the serum uric acid is included in the prediction model of RPH in this study.The increased serum uric acid can increase the incidence of RPH after PEA.It is of great significance to guide the use of diuretics in the treatment of heart failure to improve heart function,at the same time detecting the serum uric acid content to control the perioperative serum uric acid level in order to reduce the probability of RPH after PEA and improve the survival rate of CTEPH patients without pulmonary hypertension after PEA.PEA can effectively improve the PAS patients' pulmonary hemodynamics.According to the preoperative imaging examination results,the establishment of an individualized surgical scheme combined with regular postoperative chemotherapy can effectively improve the prognosis of patients with PAS.