Our experience of surgical treatment for chronic pulmonary thromboembolism

Chronic pulmonary thromboembolism is one of the causes of pulmonary hypertension and carries a poor prognosis. Medical therapy is generally unsatisfactory, and surgery provides the only possibility of a cure. Though over 1400 cases have undergone pulmonary thromboendarterectomy (PTE) worldwide, the surgical procedure is performed with success only at a few institutions. It is important to select suitable patients, to perform PTE (not an embolectomy) and to manage successfully postoperatively. We report our experiences of surgical treatment for chronic pulmonary thromboembolism. Between June 1986 and March 2001, 50 patients (15 men, 35 women) underwent PTE at our hospital. The mean age was 51.3 years (range 22-73). We have adopted two surgical approaches to PTE. The number of operation deaths was 9 (18.0%). Forty-one patients survived, and the declines in their mean pulmonary arterial pressures (m-PAP) and pulmonary vascular resistance (PVR), and the inceraeses in cardiac indices (C.I.), were significant postoperatively. Their PaO2 improved significantly after 6 months. The symptoms were markedly reduced, and survival after PTE was 86-88% at 10 years. The only therapeutic alternative to PTE is lung transplantation. The great advantage of PTE includes an excellent long-term results without the risks associated with chronic immunosuppression and potential for chronic allograft rejection. We conclude that PTE can improve the prognosis of selected patients with chronic pulmonary thromboembolism, and morphological classification by CT scan could be useful for predictions about the surgical accessibility.