Technique and outcomes of pulmonary endarterectomy surgery

Pulmonary endarterectomy (PTE) is the definitive treatment for chronic pulmonary hypertension resulting from thromboembolic disease. Chronic thromboembolic pulmonary hypertension is estimated to occur in approximately 4% of patients who have developed an acute pulmonary embolism, though the true prevalence is suspected to be much higher. Chronic thromboembolic pulmonary hypertension is characterized by intraluminal thrombus organization, fibrous stenosis, and vascular remodeling of pulmonary vessels. PTE is an operation considered to be a curative for this affliction and is therefore superior to transplantation. The procedure involves the removal of organized and incorporated fibrous obstructive tissue from the pulmonary arterial tree and is a true endarterectomy, not an embolectomy. Surgical outcomes with respect to functional status, quality of life, hemodynamics, right ventricular function, and gas exchange are favorable. Preoperative hemodynamic severity and site of anatomical obstruction are key predictors of postoperative outcome. This article focuses on the surgical techniques and outcomes of patients undergoing PTE for chronic thromboembolic pulmonary hypertension and discusses the currently known factors that affect survival after this operation.