The actuarial survival analysis of the surgical and non-surgical therapy regimen for chronic thromboembolic pulmonary hypertension

Aim To characterize the in-hospital mortality and the actuarial survival of surgical and non-surgical therapy regimen in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Methods A retrospective cohort study was conducted in 504 patients with CTEPH, who were treated surgically (n = 360), or non-surgically (n = 144) in Anzhen Hospital from February 1989 to August 2007. The patients in surgical group received a standard pulmonary thromboendarterectomy (PTE), while those in non-surgical group were given thrombolytic therapy. The actuarial survival of the two groups was determined with the Kaplan–Meier survival curves. Univariate analysis and multivariate binary logistic regression and Cox proportional hazard analysis were used to identify the risk factors for the in-hospital and late deaths. Results The in-hospital mortality for the surgical group and non-surgical group were 4.44% and 3.50%, respectively. For the proximal type of CTEPH, the actuarial survival at 10 and 15 years of the surgical group and non-surgical group were 94.60 ± 2.38%, 90.96 ± 4.24% and 81.4 ± 7.14%, 56.43 ± 14.7%, respectively (χ² = 12.33, P = 0.0004). For the distal type of CTEPH, the actuarial survival at 10 and 15 years of the surgical group and non-surgical group were 71.78 ± 4.66%, 29.57 ± 15.1% and 69.84 ± 7.78%, 32.59 ± 13.7%, respectively (χ² = 0.03, P = 0.874). Conclusion The PTE procedure has statistically superiority over thrombolytic therapy for the proximal type of CTEPH in terms of actuarial survival; however, for the distal type of CTEPH, the PTE procedure provides no benefits with regard to actuarial survival.