Surgery for chronic thromboembolic pulmonary hypertension.

The modern era of surgery for chronic thromboembolic pulmonary hypertension (CTEPH) began just over 10 years ago. Until that time pulmonary thromboendarterectomy (PTE) was performed infrequently and essentially at a single medical center (University of California at San Diego-UCSD). It posed a formidable technical challenge and was associated with both high operative mortality (> 20%) and excessive morbidity due to respiratory and multiorgan system failure. Currently PTE is performed at numerous medical centers throughout the world, largely due to the pioneering efforts of those surgeons who developed and perfected the operation at UCSD. Operative mortality rates have fallen, and postoperative complications have become less common. Although no longer simply an autopsy curiosity, CTEPH continues to be an underdiagnosed condition. Increased awareness and better diagnosis will lead to curative surgery in more patients worldwide.