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Pulmonary thromboendarterectomy in Portugal: Initial experience
1Serviço de Cirurgia Cardiotorácica, Hospital de Santa Marta, Centro Hospitalar e Universitário de Lisboa Central (CHULC), Nova Medical School, Lisboa, Portugal.
Insights
Pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH) is feasible and safe. A dedicated team at Hospital de Santa Marta achieved good survival and functional recovery in 19 patients, with outcomes improving post-training.
Area of Science:
- Cardiovascular Surgery
- Pulmonary Hypertension Research
- Thoracic Medicine
Background:
- Chronic thromboembolic pulmonary hypertension (CTEPH) poses surgical challenges, necessitating international referrals for Portuguese patients.
- Hospital de Santa Marta established a dedicated pulmonary thromboendarterectomy (PTE) program to address this need.
- This study presents outcomes for the initial 19 patients treated in the program.
Purpose of the Study:
- To evaluate the safety and efficacy of a newly established pulmonary thromboendarterectomy (PTE) program for CTEPH.
- To report the early and late outcomes of the first 19 patients undergoing PTE at Hospital de Santa Marta.
- To assess the learning curve and reproducibility of PTE outcomes.
Main Methods:
- Retrospective analysis of 19 patients undergoing PTE between 2008 and April 2019.
- Data collection included perioperative outcomes, complications, and long-term functional recovery.
- Outcomes were analyzed in relation to team training and procedural experience.
Main Results:
- Initial perioperative mortality occurred before formal team training; no early deaths were observed post-training.
- Three late deaths were recorded, all in patients with residual pulmonary arterial hypertension.
- Surviving patients demonstrated significant functional recovery (NYHA class I or II) at long-term follow-up.
Conclusions:
- Pulmonary thromboendarterectomy (PTE) is a complex procedure where outcomes correlate with surgical volume and team experience.
- A dedicated, well-trained team can achieve safe and reproducible PTE results.
- Continued patient volume and multidisciplinary collaboration are essential for further outcome improvement.
Introduction:
Surgical treatment for chronic thromboembolic pulmonary hypertension (CTEPH) is challenging. Most Portuguese patients with CTEPH have been referred to foreign institutions for treatment, with significant social and economic costs. To meet this emerging need, the cardiothoracic surgery department of Hospital de Santa Marta, Lisbon, has developed a dedicated program for pulmonary thromboendarterectomy (PTE). We hereby present the results for the first 19 patients treated.
Methods:
We conducted a retrospective analysis of all 19 patients who underwent PTE at Hospital de Santa Marta between 2008 and April 2019.
Results:
Since 2008, a total of 19 patients have undergone PTE in our department. The procedure was performed with good outcomes in both survival and functional recovery. At the very beginning of the series two patients died perioperatively, before all the team underwent formal training at the Royal Papworth Hospital, UK, with no early deaths since. Postoperative complications were similar to other published series. During 11 years of follow-up, there were three late deaths, all in patients with residual pulmonary arterial hypertension. At the latest follow-up (October 2019), all surviving patients showed significant functional recovery, all in NYHA class I or II, with only one patient on vasodilator therapy with sildenafil (the first in the series, operated in 2008).
Conclusions:
PTE is a demanding procedure, in which outcomes are related to volume and accumulated experience, however it can be performed safely and with reproducible results by a properly prepared dedicated team with a well-controlled learning curve. More patients and multidisciplinary experience will be needed to further improve and streamline results.