Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension

Introduction. Pulmonary thromboendarterectomy is considered the potentially curative treatment for chronic thromboembolic pulmonary hypertension. Material and methods. From February 1996 to May 2006, 20 patients with chronic thromboembolic pulmonary hypertension underwent pulmonary thromboendarterectomy. 90% (18/20) were in New York Heart Association functional class III-IV. Preoperative hemodynamic data were: systolic pulmonary artery pressure 86 +/- 17 mmHg, mean pulmonary artery pressure 49 +/- 9 mmHg, pulmonary total resistance 1081 +/- 553 dynes(center dot)s(center dot)cm(-5), pulmonary vascular resistance 954 +/- 427 dynes(center dot)s(center dot)cm(-5) and cardiac index 2.2 +/- 0.6 l/min/m(2). Results. Pulmonary thromboendarterectomy resulted in significant improvement of systolic pulmonary artery pressure (p = 0.002), mean pulmonary artery pressure (p = 0.001) and cardiac index (p = 0.002). 10 patients (50%) developed reperfusion pulmonary edema and residual postoperative pulmonary hypertension. Hospital mortality was 25% (5/20). From 2004 mortality rate has been reduced, and was 1 of the latest 10 patients operated on (10%). Hospital mortality is influenced by preoperative pulmonary vascular resistance (p = 0.029), preoperative mean pulmonary artery pressure (p = 0,050), postoperative systolic pulmonary artery pressure (p = 0.048) and postoperative mean pulmonary artery pressure (p = 0.003). Survival after pulmonary thromboendarterectomy is 60% at 10 years; reperfusion pulmonary edema (p = 0.046) and residual postoperative pulmonary hypertension (p = 0.028) are predictors for long-term survival. Through long-term follow-up, functional status, 6 min walking distance, end-diastolic right ventricle size, tricuspid regurgitation and systolic pulmonary pressure significantly improved (p = 0.004; p = 0.027; p = 0.003; p = 0.02; p = 0.001). Conclusions. Pulmonary thromboendarterectomy effectively reduces pulmonary hypertension and offers chronic thromboembolic pulmonary hypertension patients substantial improvement in survival and quality of life.