Pulmonary endarterectomy: A curative treatment for patients with chronic thromboembolic pulmonary hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) occurs in a minority of patients following a single or recurrent episode of pulmonary embolism and, without intervention, it has a bad prognosis. The patient typically presents with exertional dyspnea, although diagnosis is often delayed. The ventilation-perfusion lung scan, followed by right-sided heart catheterization and pulmonary angiography remain the gold standard for diagnosis. Operability is assessed by an interdisciplinary expert team. A pulmonary endarterectomy (PEA) is characterized by removal of the fibrotic transformed intima from the pulmonary arteries. This is a complex and technically challenging surgical procedure. With cardiopulmonary bypass, the patient is cooled to 20°C, followed by periods of circulatory arrest during 20 minutes. PEA is the only curative treatment that gives CTEPH patients the best chances on an improved survival and better functional status. Balloon pulmonary angioplasty is an alternative treatment, primarily for the elderly and frail for whom a high-risk cure may be less desirable than a low-risk palliation. Medical treatment is only useful for inoperable CTEPH or in cases of residual pulmonary hypertension after PEA. The early consideration of CTEPH as possible cause of dyspnea, quickly followed by the diagnostic algorithm and a PEA could annually avoid dozens of deaths in Belgium.

Publication year:2017