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Pulmonary endarterectomy: technique and pitfalls.

Stefan Guth¹, Eckhard Mayer¹, Diethard Prüfer¹

¹Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.

Annals of Cardiothoracic Surgery

|April 18, 2022

Summary

Chronic thromboembolic pulmonary hypertension (CTEPH) affects about 3% of patients post-pulmonary embolism. Pulmonary endarterectomy (PEA) surgery offers a chance for cure in eligible patients, requiring expert evaluation.

Keywords:

Chronic thromboembolic pulmonary hypertension (CTEPH)balloon pulmonary angioplasty (BPA)pulmonary endarterectomy (PEA)

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Area of Science:

Cardiology
Pulmonary Medicine
Surgical Innovation

Background:

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, underdiagnosed condition following acute pulmonary embolism.
Approximately 3% of patients develop CTEPH, with two-thirds being potential surgical candidates.
Current treatments include pulmonary arterial hypertension medication and balloon pulmonary angioplasty, alongside surgery.

Purpose of the Study:

To provide a comprehensive overview of the evaluation, indication, and surgical management of CTEPH.
To highlight the role of Pulmonary Endarterectomy (PEA) as a primary treatment modality.
To emphasize the importance of evaluation in specialized CTEPH centers.

Main Methods:

Review of current literature and clinical guidelines for CTEPH management.
Description of the Pulmonary Endarterectomy (PEA) procedure, including the necessity of deep hypothermic circulatory arrest.
Discussion on patient selection and multidisciplinary assessment.

Main Results:

Pulmonary Endarterectomy (PEA) is a complex yet standardized surgical procedure.
Deep hypothermic circulatory arrest is essential for optimal visualization during PEA.
Expert center evaluation ensures appropriate therapeutic strategies.

Conclusions:

CTEPH requires specialized evaluation to determine the best treatment pathway.
Pulmonary Endarterectomy (PEA) is a definitive treatment for selected patients.
Multimodal treatment approaches are crucial for managing CTEPH effectively.