PT  - JOURNAL ARTICLE
AU  - Andrea M. D'Armini
AU  - Marco Morsolini
AU  - Gabriella Mattiucci
AU  - Valentina Grazioli
AU  - Nicola Vistarini
AU  - Roberto Dore
TI  - Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension with distal lesions
DP  - 2013 Sep 01
TA  - European Respiratory Journal
PG  - P2599
VI  - 42
IP  - Suppl 57
4099  - http://erj.ersjournals.com/content/42/Suppl_57/P2599.short
4100  - http://erj.ersjournals.com/content/42/Suppl_57/P2599.full
SO  - Eur Respir J2013 Sep 01; 42
AB  - BackgroundAs there are no well-defined criteria to discriminate proximal from distal obstructive lesions in chronic thromboembolic pulmonary hypertension (CTEPH), the operability assessment for pulmonary endarterectomy (PEA) remains the major concern.AimThe intraoperative classification of CTEPH describes different types of arterial obstruction, based on anatomy and location. We describe our experience with the more distal disease (type 3).MethodsFrom 1994, 458 PEAs were performed at our center. From 2005 onward, the operability assessments and the operations were carried out by one surgeon. Into the cohort of 313 consecutive patients (pts) operated from 2005 to 2012, 88 (28%) presented with type 3 CTEPH, and 225 (72%) with type 1 or 2.ResultsThe comparison between the 2 groups is shown in table. Thirty-three (37.5%) pts with type 3 disease were younger than 60 years and were severely symptomatic, and would otherwise have been included in lung transplantation (LTx) waiting list.View this table:ConclusionIn experienced centers, PEA is a successful and safe operation even when performed in pts presenting with distal CTEPH. Pts should not be considered inoperable unless they have been referred to an experienced surgeon, as they could benefit from conservative surgery instead of LTx.