Current early results of pulmonary thromboendarterectomy for chronic pulmonary embolism.
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.
Daily
P O
PO
Sharp Memorial Hospital, San Diego, CA.
Dembitzsky
W P
WP
Iversen
S
S
Moser
K M
KM
Auger
W
W
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