Pulmonary Endarterectomy Surgery in patients with Chronic Thromboembolic Pulmonary Hypertension

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease due to the incomplete resolution of pulmonary emboli, leading to right heart failure, with a poor survival. Pulmonary Endarterectomy (PEA) is the operation of choice for CTEPH. Reperfusion lung injury and residual pulmonary hypertension remain most serious complications.

Objectives: Evaluate the clinical outcomes and hemodynamic changes in patients with CTEPH who underwent Pulmonary Endarterectomy.

Methods: Between March 2007 and September 2018, 39 patients with CTEPH underwent PEA. Hemodynamic parameters were studied by echocardiography preoperative and postoperative. Clinical evaluation of NYHA and 6 minute walking distance were compared pre and postoperative.

Results: Overall, 39 patients (Age 49±16, males 49 %) underwent PEA. The patients were followed for an average of 19±26 months (range 1-128m). Hospital mortality was 8% (3 patients).

mean Cross clamps time was 71±27min, and mean circulatory arrest time was 29±14min. postoperatively patients had long ventilation time, ICU and hospital stay as expected (105±163h, 190±218h, 14±8d respectively) with only 1 patient requiring dialysis and 1 patient with low cardiac output syndrome.

At mean echocardiography follow-up of 18±26 months (range 1±120 months) there was a decrease in SPAP from 70±21mmHg to 45±16mmHg [p<0.001] There was an improvement in the right ventricle function from moderate-severe dysfunction in 80% of the patients to mild-normal function in 78% of patients [p<0.001]. Clinically there was improvement in Functional Class from NYHA III-IV in 79% to NYHA I-II 86% [p<0.001] at the follow up. 6 minute walk improved from a mean 331±87m pre-operatively to 425±85m at follow up [p<0.001].

Conclusion: Pulmonary endarterectomy is associated with acceptable in-hospital mortality rate and significant improvements in cardiac hemodynamics and patients exercise capacity.