Pulmonary Thromboendarterectomy Without Circulatory Arrest

Area of Science:

• Cardiovascular Surgery
• Pulmonary Hypertension
• Thromboembolic Disease

Background:

• Chronic thromboembolic pulmonary hypertension (CTEPH) significantly impacts patient quality of life and survival.
• Pulmonary thromboendarterectomy (PTE) is a definitive treatment for CTEPH, but traditional methods often require deep hypothermic circulatory arrest.
• Developing less invasive PTE techniques is crucial for improving patient outcomes.

Purpose of the Study:

• To describe a modified beating heart pulmonary thromboendarterectomy (PTE) technique using cardiopulmonary bypass (CPB).
• To evaluate the safety and efficacy of this technique in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Main Methods:

• Retrospective analysis of four CTEPH patients undergoing beating heart PTE with CPB.
• Data collection included pre- and post-operative clinical assessments, 2D echocardiography, and computed tomography pulmonary angiogram.
• Follow-up assessments evaluated clinical status, pulmonary artery pressures, and right ventricular function.

Main Results:

• The beating heart PTE technique was successfully applied in four CTEPH patients.
• Postoperative pulmonary artery pressures significantly decreased (median 46.5 mmHg to 23.5 mmHg).
• Patients showed improved right ventricular function (tricuspid annular plane systolic excursion 14 mm to 16 mm), enhanced oxygen saturation, and NYHA class I at follow-up, with no mortality.

Conclusions:

• The described modifications in beating heart PTE with CPB offer a viable alternative to deep hypothermic circulatory arrest.
• Advances in perfusion and blood conservation facilitate this technique, leading to improved patient outcomes in CTEPH treatment.
• This approach demonstrates significant hemodynamic and functional improvements in CTEPH patients.