{"doi":"10.1053/j.jvca.2025.12.013","title":"Preoperative Right Ventricle–to–Pulmonary Artery Coupling Correlates With Intensive Care Length of Stay After Pulmonary Endarterectomy","abstract":"OBJECTIVES: To investigate whether preoperative noninvasive measurement of right ventricle-to-pulmonary artery coupling, assessed by the tricuspid annular plane systolic excursion-to-pulmonary artery systolic pressure (TAPSE:PASP) ratio, is associated with perioperative outcomes following pulmonary endarterectomy (PEA). DESIGN: Retrospective, single-center cohort study. SETTINGS: Tertiary university hospital: national center for chronic thromboembolic pulmonary hypertension (CTEPH) treatment. PARTICIPANTS: Patients with CTEPH eligible for PEA. INTERVENTIONS: Patients underwent transthoracic echocardiography and right heart catheterization before undergoing PEA. The TAPSE:PASP ratio was calculated from preoperative echocardiography and dichotomized at 0.17 mm/mmHg. MEASUREMENTS AND MAIN RESULTS: The primary outcome was intensive care unit (ICU) length of stay (LOS). Secondary outcomes included vasoactive and inotropic therapy, representing perioperative hemodynamic instability. Sixty patients were included. The median TAPSE:PASP ratio was 0.20 mm/mmHg (interquartile range [IQR], 0.15-0.29 mm/mmHg); 38% of patients had ratios below 0.17 mm/mmHg. A lower TAPSE:PASP ratio was associated with higher N-terminal pro-brain natriuretic peptide levels and pulmonary vascular resistance, as well as greater right ventricular dilatation. The median ICU LOS was longer in patients with a TAPSE:PASP ratio below 0.17 mm/mmHg (96 hours [IQR, 60-218 hours] v 63 hours [IQR, 41-93 hours], p = 0.0044), with an odds ratio (OR) of 3.45 (95% confidence interval [CI], 1.16-11.11) for ICU LOS greater than 72 hours. Patients with lower TAPSE:PASP ratios had a higher (OR, 3.33; 95% CI, 1.11-10.00; p = 0.032) and prolonged (OR, 3.70; 95% CI, 1.23-11.11; p = 0.019) need for vasoactive and inotropic therapy. CONCLUSIONS: A lower preoperative TAPSE:PASP ratio was associated with prolonged ICU stay and hemodynamic compromise after PEA. The TAPSE:PASP ratio may serve as a valuable, noninvasive tool for preoperative risk stratification in patients with CTEPH undergoing surgical treatment.","journal":"Journal of Cardiothoracic and Vascular Anesthesia","year":2025,"id":549643,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.96,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1425780,"name":"Mark Stoltenberg Ellegaard","orcid":"0009-0000-9279-6269","position":1,"is_corresponding":false},{"id":1444412,"name":"Kasper Krohn Korsholm","orcid":null,"position":2,"is_corresponding":false},{"id":1257601,"name":"Jacob Valentin Hansen","orcid":"0000-0002-7017-575X","position":3,"is_corresponding":false},{"id":1257602,"name":"Jacob Gammelgaard Schultz","orcid":"0000-0002-4374-1605","position":4,"is_corresponding":false},{"id":1444413,"name":"Stine Andersen","orcid":null,"position":5,"is_corresponding":false},{"id":1444414,"name":"Mads Jønsson Andersen","orcid":null,"position":6,"is_corresponding":false},{"id":1257607,"name":"Lars Bo Ilkjær","orcid":"0000-0002-2340-1275","position":7,"is_corresponding":false},{"id":1221706,"name":"Vasileios Zochios","orcid":"0000-0001-7654-933X","position":8,"is_corresponding":false},{"id":963199,"name":"Anders Morten Grejs","orcid":"0000-0002-8850-2982","position":9,"is_corresponding":false},{"id":1379194,"name":"Peter Juhl-Olsen","orcid":null,"position":10,"is_corresponding":false},{"id":1305665,"name":"Asger Andersen","orcid":"0000-0002-9492-7215","position":11,"is_corresponding":false},{"id":1230320,"name":"Mads Dam Lyhne","orcid":"0000-0001-5279-260X","position":0,"is_corresponding":true}],"reference_count":45,"raw_metadata":null,"created_at":"2026-07-19T02:54:07.823422Z","pmid":"41539900","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}