Pulmonary thromboendarterectomy in Portugal: Initial experience

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.