Persistent exercise limitation after successful pulmonary endoarterectomy: frequency and determinants

Abstract

After successful pulmonary endoarterectomy (PEA), patients may still suffer from exercise limitation, despite normal pulmonary vascular resistance.

Objectives: To evaluate the proportion of these patients and the determinants of exercise limitation, including respiratory function parameters and COPD.

We retrospectively evaluated a cohort of 261 patients followed up at 12 months, out of 553 patients treated with PEA from 2008 to 2016 at our institution. They underwent clinical, haemodynamic, echocardiographic and respiratory function tests preoperatively and after surgery at hospital discharge, at 3 months and then yearly for 5 years. A reduced exercise capacity was defined as Bruce test distance <400 m or PaO2 at rest below 60 mmHg.

Exercise limitation 12 months after PEA was present in 74 patients (41%, 95%CI 34% to 48%). The presence of COPD was more than double in patients with exercise limitation than in the others. Patients with persistent exercise limitation had significantly higher mPAP, PVR, HR and significantly lower RVEF, pulmonary arterial compliance, CI, VC, TLC, FEV1, FEV1/VC, DLCO, HbSaO2 than patients without. The multivariate model shows that pulmonary compliance at rest and TAPSE are important predictors of exercise capacity. Age, COPD, respiratory function parameters and unilateral surgery were also retained.

Conclusions: After successful PEA, the follow up should include exercise testing because a consistent proportion of patients continues to suffer from exercise limitation. Besides cardiac parameters, useful information are provided by respiratory function parameters and COPD diagnosis. This can better address the appropriate therapeutic approach.