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Reoperative pulmonary thromboendarterectomy
M Mo1, D P Kapelanski, S N Mitruka
1Division of Cardiothoracic Surgery, University of California, San Diego, USA.
The Annals of Thoracic Surgery
|December 10, 1999
Summary
Repeat pulmonary thromboendarterectomy (PTE) has comparable mortality to primary PTE but less hemodynamic improvement. Proper initial surgery and management can prevent most reoperative PTE needs.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pulmonary Hypertension
Background:
- Recurrent symptomatic pulmonary hypertension after primary pulmonary thromboendarterectomy (PTE) is uncommon.
- This study reviews reoperative PTE to identify risk factors and outcomes.
Purpose of the Study:
- To determine risk factors for recurrent pulmonary hypertension after PTE.
- To evaluate selection criteria, risks, and functional outcomes of reoperative PTE.
Main Methods:
- Compared 13 reoperative PTE patients with 225 primary PTE patients.
- Analyzed preoperative and postoperative pulmonary hemodynamic data and outcomes.
Main Results:
- Reoperative PTE had similar operative mortality (7.7% vs 8.4%) but less favorable hemodynamic improvement.
- Factors for reoperation included prior surgery elsewhere, unilateral PTE, coagulation disorders, ineffective filters, and anticoagulation issues.
Conclusions:
- Reoperative PTE is feasible with comparable perioperative risk to primary PTE.
- Improved initial bilateral PTE, effective filtration, and anticoagulation management can prevent most reoperations.