title: Interventional and surgical modalities of treatment for pulmonary arterial hypertension.
abstract: Beyond medical therapy, different interventional and surgical approaches exist for treatment of pulmonary arterial hypertension (PAH). Atrial septostomy has been applied in patients with lack of response to medical therapy in the absence of other surgical treatment options. With growing experience, procedure-related death rates have been reduced to 5.4%, and the most suitable patient group has been identified among patients with a mean right atrial pressure between 10 and 20 mm Hg. Pulmonary endarterectomy is the accepted form of treatment for patients with chronic thromboembolic pulmonary hypertension. Establishing the diagnosis and the classification of the type of lesions by pulmonary angiography is crucial for optimal patient selection. Perioperative mortality rates have been reduced to <10% in experienced centers, and the hemodynamic improvement is dramatic and sustained. Lung and heart-lung transplantation remains the procedure of choice for patients unsuitable for other treatment modalities. Timing of the procedure is difficult because waiting times vary between centers and usually are in a high range. Early referral of patients unresponsive to other treatment forms is therefore of importance to avoid transplantation of patients with established significant comorbidity. The survival rate during the first five years after transplantation for PAH is intermediate among the lung diseases, lower than chronic obstructive pulmonary disease but higher than idiopathic pulmonary fibrosis.
authors.affiliation: Department of Cardio-Thoracic Surgery, Vienna University Hospital, Vienna, Austria. walter.klepetko@meduniwien.ac.at
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
authors.forename: Eckhard
authors.initials: E
authors.lastname: Mayer
authors.forename: Julio
authors.initials: J
authors.lastname: Sandoval
authors.forename: Elbert P
authors.initials: EP
authors.lastname: Trulock
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Vachiery
authors.forename: Phillippe
authors.initials: P
authors.lastname: Dartevelle
authors.forename: Joanna
authors.initials: J
authors.lastname: Pepke-Zaba
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Jamieson
authors.forename: Irene
authors.initials: I
authors.lastname: Lang
authors.forename: Paul
authors.initials: P
authors.lastname: Corris
mesh_terms: D002404:Catheterization; D004691:Endarterectomy; D016041:Heart-Lung Transplantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery / Q000628:therapy*; D018579:Patient Selection; D011651:Pulmonary Artery / Q000473:pathology* / Q000601:surgery*