title: Current early results of pulmonary thromboendarterectomy for chronic pulmonary embolism.
abstract: Some patients with chronic pulmonary embolism causing severely symptomatic pulmonary hypertension have been managed by heart-lung transplantation with an associated hospital mortality of 24%. To allow comparison with pulmonary thromboendarterectomy (PTE), we have reviewed the hospital morbidity and mortality in 149 consecutive patients. From 1 October 1984 to 18 September 1989, these patients underwent PTE utilizing a standardized procedure consisting of median sternotomy, cardiopulmonary bypass, deep hypothermia and circulatory arrest for bilateral PTE in 91% (136/149) of the procedures with 7.4% (11/149) and 1.3% (2/149) undergoing right or left PTE, respectively. Ventilator dependency (greater than or equal to 5 days on respirator) occurred in 28.3% (41/146). Hospital mortality (death within 30 days or in hospital) was 11.4% (17/149). The most common causes of death were respiratory and multiorgan failure, 10 (59% of deaths) and acute pulmonary hemorrhage, 3 (17% of deaths). We conclude that PTE with an operative mortality of half that of heart-lung transplantation (11.4% vs. 24%) should be the procedure of choice for significantly symptomatic chronic pulmonary embolism. Furthermore, the hazards of immunosuppression and chronic graft rejection are avoided.
authors.affiliation: Sharp Memorial Hospital, San Diego, CA.
authors.forename: P O
authors.initials: PO
authors.lastname: Daily
authors.forename: W P
authors.initials: WP
authors.lastname: Dembitzsky
authors.forename: S
authors.initials: S
authors.lastname: Iversen
authors.forename: K M
authors.initials: KM
authors.lastname: Moser
authors.forename: W
authors.initials: W
authors.lastname: Auger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D002908:Chronic Disease; D004691:Endarterectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D016041:Heart-Lung Transplantation / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000209:etiology; D011655:Pulmonary Embolism / Q000601:surgery*; D015427:Reperfusion Injury / Q000209:etiology; D014655:Vascular Resistance