Pulmonary thromboendarterectomy.

Although PTE is potentially curative for thromboembolic pulmonary hypertension, probably fewer than 1500 of these operations have been performed worldwide. Unquestionably, the disease is under-recognized, and even among cardiac surgeons PTE is considered very hazardous and perhaps of questionable long-term benefit. Our experience does not support this view. There is neither disagreement regarding the poor prognosis of patients with pulmonary hypertension nor the unsatisfactory results of medical treatment for this disease. The only surgical alternative to PTE is lung transplantation. Compared to lung transplantation, PTE offers a lower surgical mortality rate, better long-term survival, and fewer chronic complications. The mortality rate for PTE at our centre is now in the range of 5-7%, with documented sustained functional improvement in survivors. These results clearly favour PTE as the primary treatment for thromboembolic pulmonary hypertension, and physicians should be encouraged to identify patients with this now curable disease.