Technical advances of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension

Objective: To minimize the side-effects of circulatory arrest times and profound hypothermia in patients undergoing pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Between March 2000 and June 2002, 30 patients (in New York Heart Association (...

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Bibliographic Details
Published in:European journal of cardio-thoracic surgery 2003-05, Vol.23 (5), p.776-781
Main Authors: Hagl, Christian, Khaladj, Nawid, Peters, Tina, Hoeper, Marius M., Logemann, Frank, Haverich, Axel, Macchiarini, Paolo
Format: Article
Language:English
Subjects:
Chronic Disease
Chronic thromboembolic hypertension
Cohort Studies
Critical Care - methods
Endarterectomy - methods
Female
Humans
Hypertension, Pulmonary - surgery
Length of Stay
Male
Middle Aged
Moderate hypothermia
Postoperative Care - methods
Preoperative Care - methods
Pulmonary Embolism - surgery
Pulmonary thromboendarterctomy
Reperfusion lung injury
Selective anterograde cerebral perfusion
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Summary:Objective: To minimize the side-effects of circulatory arrest times and profound hypothermia in patients undergoing pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Between March 2000 and June 2002, 30 patients (in New York Heart Association (NYHA) class III or IV) were operated for CTEPH using our modified technique. It includes moderate hypothermic (28–32°C), total cardiopulmonary bypass (CPB) and simultaneous selective antegrade cerebral perfusion and occlusion of the bronchial arteries by introducing an occlusive balloon catheter into the descending aorta. The preoperative pulmonary vascular resistance in the cohort was 873±248 dynes/s/cm−5. Results: Mean total CPB, cross-clamp times and duration of anterograde cerebral perfusion were 132±40, 98±21 and 21±10 min, respectively. Mean core temperature 29.5±1.9°C. The duration of postoperative mechanical ventilatory support was 34±44 h and the mean stay in the ICU was 5±9 days. Seven patients had mild to moderate lung reperfusion injury, one transient neurological dysfunction. Three patients (10%) died during their hospital stay, two for multiorgan failure and one for persistent pulmonary hypertension. All patients had a significant pulmonary hemodynamic improvement and all achieved NYHA class I (P
ISSN:1010-7940
1873-734X
DOI:10.1016/S1010-7940(03)00029-0