Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension--A single-center experience in Taiwan.

Abstract

Pulmonary endarterectomy (PEA) is a potentially curative surgical procedure for patients with chronic thromboembolic pulmonary hypertension. The aim of this study is to review our institutional experience with this operation. We conducted a retrospective review of PEA performed at our institution between January 2005 and December 2013. The measured outcomes were inhospital complications, improvement in cardiac function and exercise capacity, and actuarial survival after PEA. Ten consecutive patients (7 women, 3 men) underwent PEA with a mean age of 59.9±12.9 years. The preoperative New York Heart Association functional class (NYHA FC) for these patients was either Class III (n=6) or Class IV (n=4). The period from symptom onset to diagnosis was 34.3±37.9 months, and that from diagnosis to operation was 31.4±46.8 months. After PEA, the duration of intensive care unit stay and hospital stay prior to discharge were 9.7±5.7 days and 18.7±7.4 days, respectively. Postoperative complications included reperfusion lung edema (n=3) and pneumonia (n=1), and all recovered with medical therapy. After a mean follow-up of 48.4±35.1 months, all patients showed marked improvements in their clinical status and were still alive without evidence of disease recurrence. With proper patient selection, the cooperation of a multidisciplinary team, and meticulous postoperative management, PEA can be conducted safely with relatively low risk at a center with limited experience with the procedure.