[Chronic thromboembolic pulmonary hypertension: surgical treatment with thromboendarterectomy].

BACKGROUND AND OBJECTIVES: Pulmonary thromboendarterectomy (PTE) is considered the potential curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We analysed the results of the PTE application in our institution. PATIENTS AND METHODS: From February 1996 to December 2007, 30 patients with CTEPH underwent video-assisted PTE. Preoperative hemodynamic data were: systolic pulmonary artery pressure (SPAP) 87+/-17mmHg, mean pulmonary artery pressure (MPAP) 51+/-11mmHg, pulmonary total resistance 1067+/-485dynes x s x cm(-5), pulmonary vascular resistance 873+/-389dynes x s x cm(-5) and cardiac index 2.2+/-0.5l/min/m(2). We analysed the influence of several factors on hospital mortality and survival, and we performed partial analysis of mortality since 2004.
RESULTS: PTE resulted in significant improvements in SPAP (P<0.001), MPAP (P=0.001) and cardiac index (P<0.001). Hospital mortality was 17% (5/30) (95% confidence interval, 6%-35%). From 2004, it dropped to 5% (1/20) (95% confidence interval, 0%-25%). Hospital mortality was influenced by preoperative pulmonary total resistance, preoperative pulmonary vascular resistance, postoperative SPAP, reduction of SPAP, reduction of MPAP, reperfusion pulmonary oedema and residual postoperative pulmonary hypertension (P=0.036; P=0.018;P=0.013; P=0.050; P=0.050; P=0.030; P=0.045). Survival after PTE, including hospital mortality, was 76+/-9% at 10 years. Through long-term follow-up, functional status (P=0.001), 6min walking distance (P=0.001), end-diastolic right ventricle size (P<0.001), and tricuspid regurgitation (P<0.001) significantly improved.
CONCLUSIONS: PTE effectively reduces pulmonary hypertension and offers CTEPH patients a substantial improvement in survival and quality of life.