Pulmoner Endarterektomi Operasyonlarında Anestezi ve Komplikasyonların Yönetimi

Abstract

Objective: Chronic thromboembolic pulmonary hypertension is a chronic progressive disease developing obstruction ocurring in pulmonary vascular bed. Pulmonary endarterectomy is the surgical procedure described in the management of chronic pulmonary hypertension which excises, and removes the obstructing thromboembolic material from the affected vascular structures. Our aim is to share our approaches to the management of anesthesia and complications in pulomanry endarterectomy operations performed in our center. Methods: The data of 200 PEA cases conducted in June 2017-2020 were retrospectively analyzed. The demographic data of the patients, preoperative pulmonary function tests, cardiac catheterization findings, peroperative cardiac output measurement values, aortic cross clamp, extubation, intensive care unit, and hospital stay times and complications were recorded. Results: Average age of the patients’ ages was 50.8 years, and female/male ratio was 108/92. In the thermodilution measurements of the patients after induction, mean values of CO, PVR and mPAP were determined as 4.4 l/min, 594 dyn/s/cm-5, 40 mmHg, respectively. The corresponding measurements made after the sternal closure were stated as 6 l/min, 241 dyn/s/cm-5 and 28 mmHg, respectively. The patients were hospitalized in the intensive care unit for 4 days. In our patient group residual pulmonary hypertension occurred in 21%, reperfusion pulmonary edema in 10% and pulmonary bleeding in 4% of the cases. Conclusion: Only a very few centers in the world are experienced in PEA surgery. Anesthesia management and treatment of the complications of PEA surgery are quite difficult. Therefore, PEA surgery shl be performed in experienced centers.