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Pulmonary endarterectomy: experience and lessons learned in 1,500 cases
Stuart W Jamieson1, David P Kapelanski, Naohide Sakakibara
1Division of Cardiothoracic Surgery, Department of Anesthesia, UCSD Medical Center, San Diego, California, USA. sjamieson@ucsd.edu
The Annals of Thoracic Surgery
|November 7, 2003
Summary
Pulmonary endarterectomy is a curative surgical treatment for chronic thromboembolic pulmonary hypertension. This procedure has become safer and more effective, with a low mortality rate of 4.4% in recent patients.
Area of Science:
- Cardiovascular Surgery
- Pulmonary Hypertension
- Thromboembolic Disease
Background:
- Chronic thromboembolic pulmonary hypertension (CTEPH) incidence is underestimated.
- Medical therapy for CTEPH is supportive; surgical therapy is curative.
- Pulmonary endarterectomy programs have evolved significantly since 1970.
Purpose of the Study:
- To assess the safety and efficacy of pulmonary endarterectomy.
- To evaluate outcomes based on surgical experience.
- To analyze results from the last 500 consecutive patients.
Main Methods:
- Pulmonary endarterectomy utilizing median sternotomy, cardiopulmonary bypass, profound hypothermia, and circulatory arrest.
- Detailed examination of the last 500 consecutive patient outcomes.
- Assessment of pulmonary artery pressures and resistance.
Main Results:
- Surgical techniques allow complete removal of occluding material, addressing all levels of pulmonary vascular obstruction.
- Cerebral impairment has been eliminated through optimized cooling and shorter circulatory arrest times.
- The overall mortality rate has decreased to 4.4% (22 of 500 patients).
Conclusions:
- Pulmonary endarterectomy is a curative treatment for CTEPH, superior to lung transplantation.
- Modern surgical techniques have rendered the procedure relatively safe and highly effective.