Perioperative care of patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy - twenty years of experience at an expert Centre in the Czech Republic

This year marks the 20th anniversary of the launch of the chronic thromboembolic pulmonary hypertension (CTEPH) surgical treatment programme, which involves three departments of the Cardiac Centre of the General University Hospital in Prague. Diagnosis and decision-making on the type of treatment, including indication for surgical treatment, is carried out at the Centre. Other non-surgical treatments and long-term dispensary care are also available to patients. Over 500 patients with CTEPH have been operated on during the program's lifetime. Our Centre also concentrates on patients with other types of severe pulmonary hypertension who are indicated for various challenging surgical procedures, as they can be offered comprehensive perioperative care by experienced anaesthetists and intensivists. Anaesthesia and intensive postoperative care of patients indicated for pulmonary endarterectomy has certain specifics, which are based on the fact that patients undergoing this operation have right-sided heart failure with chronic low cardiac output, are significantly symptomatic, and have minimal circulatory and ventilatory reserves. In addition, they are at risk of developing several serious complications during the surgeryand in the early postoperative period, which increase morbidityand mortality. This review work is based on twenty years of experience at our center, many of which have been materialized in independent original studies published in peer-reviewed journals. In addition to their practice, the authors draw on the experience of other European and international centers, many of which they have established useful collaborations with. The anaesthetic and intensive care procedures used have undergone many changes over the past twenty years and have been re-evaluated based on recommendations and experience, always to improve outcomes and reduce the rate of perioperative complications.