title: Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension: How can patients be better selected?
abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) comprises organizing thrombotic obstructions in the pulmonary arteries by nonresolving thromboemboli, formation of fibrosis and remodeling of pulmonary blood vessels. Surgical pulmonary endarterectomy (PEA) is the therapy of choice for patients with surgically accessible CTEPH, which leads to a profound improvement in hemodynamics, functional class and survival. Selecting the candidates that will benefit from surgery is still a challenging task. Criteria for surgical suitability have been described but the decision-making for or against surgical intervention remains still subjective. The optimal characterization of the reciprocal contribution of large vessel and small vessel disease in the elevation of pulmonary vascular resistance is crucial for the indication and outcome of PEA. Recently, Toshner et al intended to validate the partition resistance into small and large vessels compartments (upstream resistance: Rup) by the occlusion technique in the preoperative assessment of PEA. We discuss the advantages and disadvantages of Rup and compare it with other hemodynamic predictor to evaluate operative risk in CTEPH patients.
authors.affiliation: Juan C Grignola, Department of Pathophysiology, Faculty of Medicine, University of the Republic, Montevideo 11600, Uruguay.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Grignola
authors.forename: Enric
authors.initials: E
authors.lastname: Domingo
keywords: Chronic thromboembolic pulmonary hypertension; Operability; Pulmonary artery occluded pressure; Pulmonary endarterectomy; Pulmonary vascular resistance
references.citation: Pulm Circ. 2012 Apr-Jun;2(2):155-62
references.pmid: 22837856
references.citation: Proc Am Thorac Soc. 2006 Sep;3(7):571-6
references.pmid: 16963536
references.citation: Cardiovasc Eng Technol. 2011 Mar;2(1):15-23
references.pmid: 21423331
references.citation: Am J Physiol Heart Circ Physiol. 2006 Oct;291(4):H1731-7
references.pmid: 16699074
references.citation: Eur Respir Rev. 2010 Sep;19(117):197-203
references.pmid: 20956192
references.citation: J Thorac Cardiovasc Surg. 2011 Feb;141(2):383-7
references.pmid: 20471039
references.citation: Chest. 2009 Mar;135(3):760-768
references.pmid: 18849403
references.citation: Int J Cardiol. 2011 Dec;154 Suppl 1:S54-60
references.pmid: 22221974
references.citation: Ann Thorac Cardiovasc Surg. 2008 Oct;14(5):274-82
references.pmid: 18989242
references.citation: Circulation. 2004 Jan 6;109(1):18-22
references.pmid: 14699009
references.citation: Curr Treat Options Cardiovasc Med. 2010 Apr;12(2):131-41
references.pmid: 20376164
references.citation: World J Cardiol. 2011 Jan 26;3(1):10-7
references.pmid: 21286213
references.citation: Int J Cardiol. 2012 Jul 26;158(3):475-6
references.pmid: 22682701
references.citation: Eur Heart J. 2008 Jul;29(13):1688-95
references.pmid: 18349027
references.citation: Chest. 1973 Jul;64(1):29-35
references.pmid: 4717457
references.citation: Med Biol Eng Comput. 2009 Feb;47(2):131-41
references.pmid: 18543011
references.citation: Clin Chest Med. 2010 Dec;31(4):741-58
references.pmid: 21047580
references.citation: Eur Respir Rev. 2012 Mar 1;21(123):32-9
references.pmid: 22379172
references.citation: Am J Respir Crit Care Med. 2011 Jun 15;183(12):1605-13
references.pmid: 21330453
references.citation: Circulation. 2012 Jan 17;125(2):289-97
references.pmid: 22131357
references.citation: Eur Respir J. 2012 Sep;40(3):612-7
references.pmid: 22362857
references.citation: Eur Respir Rev. 2010 Mar;19(115):55-8
references.pmid: 20956166
references.citation: Isr Med Assoc J. 2011 Feb;13(2):106-10
references.pmid: 21443038