Pulmonary endarterectomy: is there an alternative to profound hypothermia with cardiocirculatory arrest?

The current surgical strategy for pulmonary endarterectomy (PEA) involves the use of extracorporeal circulation and hypothermic circulatory arrest (HCA). The aim of the present study was to test the feasibility of a different strategy of extracorporeal circulation, which could prevent bronchial back bleeding and allow a bloodless operating field, avoiding the risks associated with HCA in patients undergoing pulmonary endarterectomy. Between June 2004 and September 2005, eight patients underwent PEA without HCA. We introduced a double venting of the left heart sections, utilizing two cannulas placed in the left ventricle and atrium. Both vent cannulas are connected with vacuum device to prevent back-bleeding and left heart distension from the large amount of bronchial flow. We were able to perform pulmonary endarterectomy avoiding circulatory arrest and deep hypothermia without sacrificing the effectiveness of the procedure. The initial encouraging results have convinced us to apply systematically this technique in the cases operated in our center, even though further investigations are necessary to fully examine this technique.