EXPRESS: Sex and survival following pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a Scandinavian observational cohort study
<b>Background</b> Studies have suggested sexârelated survival differences in chronic thromboembolic pulmonary hypertension (CTEPH). Whether longâterm prognosis differs between men and women following pulmonary endarterectomy (PEA) for CTEPH remains unclear. We investigated sexâspecific survival after PEA for CTEPH. <b>Methods</b> We included all patients who underwent PEA for CTEPH at two Scandinavian centers and obtained baseline characteristics and vital statuses from patient charts and national healthâdata registers. Propensity scores and weighting were used to account for baseline differences. Flexible parametric survival models were employed to estimate the association between sex and allâcause mortality and the absolute survival differences. The expected survival in an age-, sex-, and year of surgery matched general population was obtained from the Human Mortality Database, and the relative survival was used to estimate causeâspecific mortality. <b>Results</b> A total of 444 patients were included, comprising 260 (59%) men and 184 (41%) women. Unadjusted 30âday mortality was 4.2% in men versus 9.8% in women (p=0.020). In weighted analyses, longâterm survival did not differ significantly in women compared with men (HR: 1.36; 95% CI: 0.89â2.06). Relative survival at 15 years conditional on 30âday survival was 94% (79%â107%) in men versus 75% (59%â88%) in women. <b>Conclusions</b> In patients who underwent PEA for CTEPH, early mortality was higher in women compared with men. After adjustment for differences in baseline characteristics, female sex was not associated with longâterm survival. However, relative survival analyses suggested that the observed survival in men was close to the expected survival in the matched general population, whereas survival in women deviated notably from the matched general population.