Objectives : To evaluate our early results of pulmonary thromboendarterectomy (pTEA) for patients with chronic thromboembolic pulmonary hypertension (CTEPHT).
Methods and patients : 10 Consecutive pts. (7 females and 3 males, mean age 55+11 years) underwent pTEA between June and December 1999. CPB was installed through a median sternotomy and deep hypothermia induced after which a bilateral TEA was performed under intermittent circulatory arrest (CA). Repeated invasive and non-invasive measurements were obtained before and after the operation and at 6 months follow-up.
Results : Duration of CPB was 202+24 min (range 155-226). Mean CA time was 34+13 min (range 13-51). There were no intra-operative deaths. One patient died 12 hours postoperatively of right ventricular failure due to inadequate TEA. The mean length of ventilatory support was 5,4 days (range 1-12). 3 Pts. developed reperfusion edema. Mean pulmonary artery pressure (PAP) decreased significantly from 51+14 to 29+6 mmHg. The pulmonary vascular resistance decreased from 1026+336 to 300+124 dyne.s.cm –5. The Doppler-derived Right Ventricular index improved immediately after the operation from 0,90+0,35 to 0,49+0,21 (p<0,05) and showed a further improvement over the next 6 months (0,39+0,05). The functional NYHA-class (3,1+0,6 vs. 1,7+0,8) and the 6-min walking distance (296+104 vs. 379+82) had a similar evolution with a positive correlation between RV index and NYHA-class (p<0,02).
Conclusions : In selected patients with CTEPH, pTEA offers an effective surgical therapy with acceptable mortality. The functional outcome improves significantly both hemodynamically (due to an immediate decline in PVR and PAP) and clinically because of a progressive improvement in NYHA-class and 6MWD over the first 6 months, as a result of right ventricular remodeling.