Residual Pulmonary Hypertension After Pulmonary Endarterectomy Is Associated With Female Sex, Absence of Prior Venous Thromboembolism, and Higher Preoperative Mean Pulmonary Artery Pressure

Abstract Purpose Residual pulmonary hypertension (RPH) after pulmonary endarterectomy (PEA) is associated with adverse functional and long-term outcomes. We investigated preoperative factors associated with RPH, defined as mean pulmonary artery pressure (mPAP) ≥ 25 mmHg at follow-up right heart catheterization (RHC). Methods This single-centre cohort included 205 consecutive patients with chronic thromboembolic pulmonary hypertension who underwent PEA tertiary referral centre (2015–2024). Among 174 hospital survivors, 149 (85.6%) underwent follow-up RHC at a median of 6.0 months (IQR 4.3–9.9) and comprised the primary analysis. Multivariable logistic regression was complemented by bootstrap internal validation (1,000 resamples). Results RPH was present in 80 of 149 patients (53.7%). Female sex (adjusted OR 2.21; 95% CI 1.10–4.44; p = 0.026), absence of prior venous thromboembolism (adjusted OR 3.39; 95% CI 1.12–10.23; p = 0.031), and higher preoperative mPAP (adjusted OR 1.037 per 1 mmHg; 95% CI 1.007–1.068; p = 0.016) were independently associated with RPH. The primary model showed moderate discrimination (AUC 0.693; 95% CI 0.609–0.777, DeLong method), adequate calibration (Hosmer–Lemeshow p = 0.386), and an optimism-corrected AUC of 0.675. Conclusion Female sex, absence of prior venous thromboembolism, and higher preoperative mPAP were independently associated with RPH after PEA. These readily available variables may help identify patients who warrant closer postoperative clinical and haemodynamic reassessment.