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Balloon pulmonary angioplasty improved hemodynamics, walking distance, and World Health Organization functional class in patients with chronic thromboembolic pulmonary hypertension not eligible for pulmonary endarterectomy (Non‐PEA) and patients with persistent pulmonary hypertension after PEA (PEA). More mild complications were observed in PEA‐ compared to Non‐PEA. [ABSTRACT FROM AUTHOR]

This study investigated whether residual pulmonary hypertension (PH), defined as early postoperative mean pulmonary artery pressure (mPAP) of ≥30 mmHg, after undergoing pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) was associated with longterm survival. All patients who underwent PEA for CTEPH at two Scandinavian centers were included in this study. Baseline characteristics and vital statuses were obtained from patient charts and national health‐data registers. The patients were then categorized based on residual PH measured via right heart catheterization within 48 h after undergoing PEA. Crude and weighted flexible parametric survival models were used to estimate the association between residual PH and all‐cause mortality and to quantify absolute survival differences. From 1992 to 2020, 444 patients underwent surgery. We excluded 6 patients who died on the day of surgery and 12 patients whose early postoperative pulmonary hemodynamic data was unavailable. Of the total study population (n = 426), 174 (41%) and 252 (59%) patients had an early postoperative mPAP <30 and ≥30 mmHg, respectively. After weighting, there was a significant association between residual PH and all‐cause mortality (hazard ratio: 2.49; 95% confidence interval [CI]: 1.60–3.87), and the absolute survival difference between the groups at 10 and 20 years was –22% (95% CI: –32% to –12%) and–32% (95% CI: –47% to –18%), respectively. A strong and clinically relevant association of residual PH with long‐term survival after PEA for CTEPH was found. After accounting for differences in baseline characteristics, the absolute survival difference at long‐term follow‐up was clinically meaningful and imply careful surveillance to improve clinical outcomes in these patients. Early postoperative right heart catheter measurements of mPAP seem to be helpful for prognostication following PEA for CTEPH. [ABSTRACT FROM AUTHOR]

Aims: To characterize right ventricular (RV) geometry and function in chronic thromboembolic pulmonary hypertension (CTEPH) patients at rest and during exercise before pulmonary thromboendarterectomy (PEA), and at 3 and 12 months after PEA using two‐dimensional and three‐dimensional echocardiography with reference to clinical performance and exercise capacity. Methods and results: Forty subjects (20 CTEPH patients and 20 controls) were enrolled between December 2014 and January 2017. Three‐dimensional echocardiography demonstrated a significant reduction and normalization of end‐diastolic and end‐systolic RV volumes in CTEPH patients 12 months after PEA. RV systolic function improved after PEA; however, tricuspid annular plane systolic excursion (TAPSE) (baseline 18 ± 6 mm vs 15 ± 3 mm at 12 months after PEA, P < .05) and tricuspid lateral annular systolic velocity (RV‐S′) (baseline −8.3 ± 2.1 cm/s vs −7.2 ± 1.3 cm/s at 12 months after PEA, P < .05) declined significantly after PEA. Tricuspid regurgitation gradient was 64 ± 21 mm Hg at baseline, 40 ± 14 mm Hg at 3 months, and 30 ± 13 at 12 months, P < .00001. RV free‐wall longitudinal strain at peak exercise was significantly increased from baseline (−10.6 ± 5.5%) to 12 months of follow‐up (−15.8 ± 5.2%), P < .005. Physical exercise capacity, measured as peak oxygen uptake, was significantly increased and correlated directly with improvement of resting and exercise‐induced RV‐EF. Conclusion: Improvement of RV geometry and systolic function, along with the reduction of systolic pulmonary pressure, can be expected following PEA in CTEPH patients during long‐term follow‐up. Improvement of RV myocardial contractility after PEA was only revealed at peak exercise over time. Importantly, physical exercise capacity was significantly increased and was found to be directly correlated with improvement of resting and exercise‐induced RV‐EF. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To clarify if use of adverse cardiovascular risk profile (ARP) grafts is associated with impaired long‐term outcomes after heart transplantation (HTx). Methods: Survival was obtained from Scandia Transplant and a local database. ARP donor inclusion criteria: ≥55 years, diabetes mellitus, arterial hypertension, hypoxemia‐induced death, impaired left ventricular (LV) ejection fraction. ARP donors were compared to donors not meeting the eligibility criteria. Sub‐analyses were made for donor age. Results: In total, 302 HTxs were performed in 296 patients from 31 December 1992 to 11 August 2016. Median survival was 16.5 years (95% CI, 14.3‐22.9), there was no difference between profiles (HR 0.63 (95% CI, 0.33‐1.19), P = 0.15). LV systolic function was significantly better in ARP donors (P < 0.05). Freedom from cardiac allograft vasculopathy (CAV) was comparable between profiles, HR 0.9 (95% CI 0.5‐1.5). Donor age predisposes to CAV (high to low age: HR 2.8 (95% CI 1.7‐4.5), P < 0.0001). Median survival was comparable in patients receiving allograft ≥55 and <55 years (HR 0.77 (95% CI 0.4‐1.4), P = 0.38). Conclusion: Long‐term survival and graft function were excellent in patients receiving ARP grafts. Older grafts were associated with CAV but did not influence survival. Thus, the strategy of expanding availability using ARP grafts seems safe. [ABSTRACT FROM AUTHOR]