Impact of sex, race and socioeconomic status on survival after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.

Abstract

OBJECTIVES:

Pulmonary thromboendarterectomy (PTE) is a definitive treatment for chronic thromboembolic pulmonary hypertension. Demographic-based disparities in PTE outcomes have not been well-studied.

METHODS:

We reviewed all patients who underwent PTE for chronic thromboembolic pulmonary hypertension between 2009 and 2019 at our institution, tracking demographic information including self-identified race, preoperative characteristics and 2-year survival. Socioeconomic status was assessed using the zip code-linked Distressed Communities Index, a validated holistic measure of community well-being. Survival was estimated using Kaplan-Meier method and factors associated with mortality were estimated using Cox regression.

RESULTS:

Of 235 PTE patients, 101 (42.9%) were white and 87 (37.0%) were black. White patients had a higher median age at surgery (57 vs 51 years, P = 0.035) and a lower degree of economic distress (33.6 vs 61.2 percentile, P < 0.001). Regarding sex, 106 (45.1%) patients were male and 129 (53.6%) were female. Male patients had a higher median age (59 vs 50 years, P = 0.004), greater rates of dyslipidaemia (34% vs 20.2%, P = 0.025), a lower ejection fraction (55% vs 57%, P = 0.046) and longer cross-clamp (77 vs 67.50 min, P = 0.004) and circulatory arrest times (42 vs 37.50 min, P = 0.007). No difference was observed in unadjusted 2-year survival after PTE between patients stratified by race and sex (P = 0.35). After adjustment for clinically relevant variables, neither socioeconomic status, sex nor race were associated with mortality in Cox proportional hazard analysis.

CONCLUSIONS:

Sex, socioeconomic status and race were not associated with adverse outcomes after PTE in our single-centre experience.

• Authors: Austin Y Su, Alice Vinogradsky, Amy S Wang, Yuming Ning, Elizabeth Abrahams, Matthew Bacchetta, Paul Kurlansky, Erika B Rosenzweig, Koji Takeda
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 62 Issue 2 (07 11 2022) ISSN: 1873-734X [Electronic] Germany
• PMID: 35809067 (Publication Type: Journal Article, Review)
• Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Topics

• Chronic Disease
• Endarterectomy (methods)
• Female
• Humans
• Hypertension, Pulmonary
• Male
• Middle Aged
• Pulmonary Embolism (complications)
• Social Class
• Treatment Outcome