Pulmonary Thrombo-Endarterectomy for Chronic Thromboembolic Pulmonary Artery Hypertension: 17 Years Single Center Experience. Impact of Multidisciplinary Team Approach

Abstract

Purpose Chronic thromboembolic pulmonary hypertension (CTEPH) is the only type of pulmonary hypertension (PH) with a surgical resolution which is the Pulmonary Thrombo-Endarterectomy (PTE) operation. Fibrotic thrombus extraction allows pulmonary vascular resistances (PVR) reduction until normalisation in most of cases. However, this sentence might be controversial since results are conditioned by the center experience on patients's selection, operation's timing, skills and management of such complex pathology. Seventeen years performing PTE and our multidisciplinary approach allowed us to obtain very good results. In here we report our data progress and results of PTE for CTEPH. Methods A total of 177 patients underwent PTE from 2003 until 2020. From 2003 to 2012 (Group 1) 96 patients were operated avoiding Deep Hypothermic Circulatory Arrest (DHCA) being applied only when blood bronchial flow ruled out a complete endarterectomy. Group 2, included 81 patients operated rom 2012 until the present, when DHCA was routinely adopted. Furthermore, the event of the Balloon Pulmonary Angioplasty (BPA) in 2015, conceded us a therapeutic alternative in high risk or unsuitable PTE patients. The impact of these and other variables in patients population profile and results of both groups have been retrospectively compare and analysed. Results Most relevant preoperative differences were related to worst clinical status and associated pathologies in Group 1 and wider use of specific pulmonary vasodilator in Group 2. Cross clamp time as well as time of cardiopulmonary bypass were significantly shorter in Group 2 in spite of a mean DHCA time of 33 minutes. In-hospital mortality and need of postoperative ECMO was respectively 15.6% vs 3.7% and 15.6% vs 8.6% in group 1 and 2 (p 0.001). Pulmonary hemodynamic as well as long term outcome equally and significantly improved in both groups. Conclusion Our reported results demonstrate that, DHCA is the best approach to perform PTE for CTEPH. Certainly experience, protocols and a multidisciplinary approach contribute to obtain the best hemodynamics, surgical and clinical outcomes.