Early experience with pulmonary endarterectomy in Bulgaria-case series

Area of Science:

• Cardiovascular Surgery
• Pulmonary Hypertension
• Thoracic Surgery

Background:

• Pulmonary arterial hypertension (PAH) significantly impacts quality of life and life expectancy, with high mortality rates without treatment.
• Chronic thromboembolic pulmonary hypertension (CTEPH) is a treatable form of PAH, with pulmonary endarterectomy (PEA) recommended for operable cases.
• Traditionally, Bulgarian patients requiring PEA sought treatment internationally, facing logistical and financial challenges.

Observation:

• A national PEA program was established in Bulgaria, performing surgery in two cardiac centers.
• Eleven patients aged 22-80 underwent PEA, with preoperative pulmonary vascular resistance (PVR) ranging from 309 to 1,906 dynes/sec/cm⁻⁵.
• Post-surgery, surviving patients experienced an average PVR reduction of 615 dynes/sec/cm⁻⁵ at 6 months.

Findings:

• Nine out of eleven patients survived to hospital discharge and 6-month follow-up.
• All surviving patients achieved normalized PVR and improved exercise tolerance.
• Average intensive care unit (ICU) stay was 6.7 days, and hospitalisation averaged 15.2 days.

Implications:

• The Bulgarian national PEA program demonstrates successful local treatment for CTEPH.
• Establishing such programs can improve access to care and reduce healthcare burdens for patients.
• International healthcare collaborations can facilitate the development of specialized national treatment centers.