6533b861fe1ef96bd12c41be

RESEARCH PRODUCT

Surgical treatment of chronic thromboembolic pulmonary hypertension

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description

Background: Chronic thromboembolic pulmonary artery obstruction from unresolved pulmonary emboli is characterized by persistent elevation of pulmonary vascular resistance and progressive right heart dysfunction and failure. The diagnosis of chronic thromboembolic pulmonary hypertension is difficult and often missed. Medical therapy is ineffective in these patients. The prognosis is poor and depends on the degree of pulmonary hypertension. Pulmonary thromboendarterectomy has proven to be an effective and potentially curative surgical therapy for this clinical entity although less than 1000 cases have been reported in the surgical literature. Methods: The current principles of diagnosis, patient selection for surgery, surgical technique, and postoperative management are summarized. Results: 156 pulmonary thromboendarterectomy procedures have been performed. Based on modifications of the operative and postoperative management, early mortality rates could be decreased from 24 % in 109 patients operated on before 1995 to 8.5 % in 47 patients operated on since January 1995. 56 patients reported a substantial improvement of clinical symptoms after a mean follow-up period of 31 months. At follow-up, mean pulmonary vascular resistance and pulmonary artery pressures were significantly reduced compared to preoperative and postoperative values. Conclusions: Pulmonary thromboendarterectomy is an effective and potentially curative surgical procedure for chronic pulmonary embolism. The operative risk can be decreased to an acceptable level. Long-term clinical and hemodynamic results are excellent.