Pulmonary endarterectomy in antiphospholipid syndrome: a retrospective analysis from the Saudi pulmonary hypertension registry

Background Antiphospholipid syndrome (APS) is associated with venous thromboembolism, which can lead to chronic thromboembolic pulmonary hypertension (CTEPH). Despite treatment with pulmonary endarterectomy (PEA), some patients continue to experience pulmonary hypertension (PH), which is potentially caused by APS-related distal vasculopathy. The aim of this study was to assess persistent PH after surgery and to investigate post PEA outcomes, including immediate postoperative complications, hospitalizations within 1 year of surgery, and mortality. Methods We performed a retrospective analysis of adult patients with CTEPH who underwent PEA. We included patients with and without APS. Data were obtained from the Saudi Pulmonary Hypertension Registry (2011–2022). We assessed immediate postoperative complications, rehospitalizations within 1 year, and mortality. Additionally, we evaluated patients with right heart catheterization 1 year before and after PEA for persistent PH. Results The study included 37 patients with APS-CTEPH and 41 patients without APS. Persistent PH was observed in 43% of patients, with no significant difference between the groups. Notably, patients in the APS-CTEPH group who received pulmonary vasodilator therapy before PEA had a reduced risk of developing persistent PH. Postoperative complications were significantly higher in the APS-CTEPH group ( p = 0.002). Despite these risks, the 5-year survival rate was 98.3%, with no significant difference between the groups. Conclusion APS is associated with a higher incidence of immediate postoperative complications and rehospitalizations within the 1 st year after surgery. However, APS does not appear to increase the risk of persistent PH or affect long-term mortality in this cohort.