Current surgical management of chronic thromboembolic pulmonary disease

Area of Science:

• Cardiology
• Pulmonary Medicine
• Vascular Surgery

Background:

• Chronic thromboembolic pulmonary disease (CTEPD) with or without pulmonary hypertension (PH) can arise from venous thromboembolic disease.
• Untreated CTEPD with PH (CTEPH) leads to significant morbidity and mortality.
• Treatment options for CTEPD/CTEPH include pulmonary endarterectomy (PEA), balloon pulmonary angioplasty, medical therapy, or combined approaches.

Purpose of the Study:

• To review the history and current role of PEA in Australasia for CTEPH management.
• To report outcomes from a major Australasian CTEPH expert center.
• To provide updated guidance on PEA utilization and discuss future challenges in CTEPH diagnosis and management.

Main Methods:

• Retrospective analysis of PEA outcomes at an Australasian CTEPH center.
• Review of existing literature and treatment guidelines for CTEPH.
• Discussion of patient selection criteria, surgical considerations, and multidisciplinary management.

Main Results:

• PEA can achieve excellent outcomes and disease resolution in selected CTEPH patients.
• Treatment choice is influenced by disease location, PH severity, and patient factors.
• PEA is a complex procedure with potential for serious perioperative complications.

Conclusions:

• PEA remains a cornerstone treatment for suitable CTEPH patients in Australasia.
• Optimizing patient selection and surgical expertise is crucial for successful PEA outcomes.
• Continued research and collaboration are needed to address challenges in CTEPH diagnosis and management.