Outcomes of Pulmonary Endarterectomy Surgery

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Chronic thromboembolic pulmonary hypertension has emerged as one of the leading causes of severe pulmonary hypertension. This disease is estimated to occur in approximately 1 to 5% of all patients who have previously developed an acute pulmonary embolism, although the true prevalence is suspected to be much higher. Chronic thromboembolic pulmonary hypertension is characterized by intraluminal thrombus organization, fibrous stenosis, and vascular remodeling of pulmonary vessels. Pulmonary endarterectomy is an operation that is considered curative for thromboembolic pulmonary hypertension and is therefore superior to transplantation for this condition. This article focuses on the surgical outcomes of patients undergoing pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension and discusses the currently known factors that affect survival after this operation.

Section snippets

Patient Selection

We identified and followed all patients who underwent isolated pulmonary endarterectomy from May 1998 through April 2006 at our institution. This included 956 patients (468 male and 488 female patients) who comprise the most recent data set of the UCSD Pulmonary Endarterectomy Registry. The clinical presentation of the patients varied, from those with dyspnea on exertion but otherwise well to patients transferred by air ambulance in respiratory failure with florid right heart failure and

Results

All 956 patients underwent bilateral pulmonary endarterectomy with or without foramen ovale closure. Characteristics at the time of operation for patients who underwent pulmonary endarterectomy are detailed in Table 1. The mean patient age was 51.7 ± 15.4 years, with a range of 8.9 to 84.8 years. A similar number of men and women were referred for operation, reflecting disease predilection, surgical referral bias, or both. In 10% of cases, at least one additional cardiac procedure was performed

Conclusions

Pulmonary hypertension caused by chronic pulmonary embolism is under-recognized and carries a poor prognosis. Medical therapy for this condition is ineffective and only transiently improves symptoms. The only therapeutic alternative to pulmonary endarterectomy is lung transplantation. The advantages of pulmonary endarterectomy include a lower operative mortality (3-month survival for lung transplantation for pulmonary hypertension 1990-2001, 72%; for heart–lung transplantation for pulmonary

Acknowledgments

This work was supported by NIH Grant R01-HL70852 and Center for Medical Research and Education Grant to P.A.T.

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