title: Outcome of pulmonary endarterectomy in symptomatic chronic thromboembolic disease.
abstract: Chronic thromboembolic disease is characterised by persistent pulmonary thromboembolic occlusions without pulmonary hypertension. Early surgical treatment with pulmonary endarterectomy may improve symptoms and prevent disease progression. We sought to assess the outcome of pulmonary endarterectomy in symptomatic patients with chronic thromboembolic disease. Patients with symptomatic chronic thromboembolic disease and a mean pulmonary artery pressure <25 mmHg at baseline with right heart catheterisation and treated with pulmonary endarterectomy between January 2000 and July 2013 were identified. Patients were reassessed at 6 months and at 1 year following surgery. A total of 42 patients underwent surgery and the median length of stay in hospital was 11 days. There was no in-hospital mortality but complications occurred in 40% of patients. At 1 year, following surgery, 95% of the patients remained alive. There was a significant symptomatic improvement with 95% of patients in the New York Heart Association functional classes I or II at 6 months. There was a significant improvement in quality of life assessed by the Cambridge pulmonary hypertension outcome review questionnaire. In this carefully selected cohort of chronic thromboembolic disease patients, pulmonary endarterectomy resulted in significant improvement in symptoms and quality of life. Appropriate patient selection is paramount given the known surgical morbidity and mortality, and surgery should only be performed in expert centres.
authors.affiliation: Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK.
authors.forename: Dolores
authors.initials: D
authors.lastname: Taboada
authors.affiliation: Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Pepke-Zaba
authors.affiliation: Dept of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: David P
authors.initials: DP
authors.lastname: Jenkins
authors.affiliation: Dept of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: Marius
authors.initials: M
authors.lastname: Berman
authors.affiliation: Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK.
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Treacy
authors.affiliation: Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK.
authors.forename: John E
authors.initials: JE
authors.lastname: Cannon
authors.affiliation: Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Toshner
authors.affiliation: Dept of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: John J
authors.initials: JJ
authors.lastname: Dunning
authors.affiliation: Dept of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: Choo
authors.initials: C
authors.lastname: Ng
authors.affiliation: Dept of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Tsui
authors.affiliation: Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK Karen.Sheares@papworth.nhs.uk.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Sheares
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D016208:Databases, Factual; D004417:Dyspnea / Q000209:etiology; D004691:Endarterectomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery*; D011655:Pulmonary Embolism / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome