Perioperative Management in Pulmonary Endarterectomy

Area of Science:

• Cardiothoracic Surgery
• Pulmonary Hypertension Management

Background:

• Chronic thromboembolic pulmonary hypertension (PH) requires specialized treatment.
• Pulmonary endarterectomy (PEA) is the primary surgical option for accessible disease.

Purpose of the Study:

• To detail indications, surgical strategies, and perioperative care for PEA.
• To outline management of residual PH post-PEA.

Main Methods:

• Description of specialized surgical techniques for intra-arterial fibrotic material removal.
• Emphasis on meticulous perioperative management in OR and ICU.
• Discussion of extracorporeal membrane oxygenation for severe complications.

Main Results:

• PEA demonstrates low operative mortality (<5%) in high-volume centers.
• Long-term survival exceeds 70% at 10 years post-successful PEA.
• Significant improvements in morbidity and mortality are documented.

Conclusions:

• PEA is a highly effective treatment for suitable chronic thromboembolic PH patients.
• Management of complications like RV failure and reperfusion edema is critical.
• Balloon pulmonary angioplasty and medical therapy are options for non-surgical candidates or residual PH.