title: Pulmonary thromboendarterectomy in 106 patients with chronic thromboembolic pulmonary hypertension.
abstract: BACKGROUND
  Pulmonary thromboendarterectomy is the treatment of choice in chronic thromboembolic pulmonary hypertension. We report our experience with this technique.
  
  
  METHODS
  Between February 1996 and June 2014, we performed 106 pulmonary thromboendarterectomies. Patient population, morbidity and mortality and the long-term results of this technique (survival, functional improvement and resolution of pulmonary hypertension) are described.
  
  
  RESULTS
  Subjects' mean age was 53±14 years. A total of 89% were WHO functional class III-IV, presurgery mean pulmonary pressure was 49±13mmHg and mean pulmonary vascular resistance was 831±364 dynes.s.cm(-5). In-hospital mortality was 6.6%. The most important post-operative morbidity was reperfusion pulmonary injury, in 20% of patients; this was an independent risk factor (p=0.015) for hospital mortality. With a 31-month median follow-up (interquartile range: 50), 3- and 5-year survival was 90 and 84%. At 1 year, 91% were WHO functional class I-II; mean pulmonary pressure (27±11mmHg) and pulmonary vascular resistance (275±218 dynes.s.cm(-5)) were significantly lower (p<0.05) than before the intervention. Although residual pulmonary hypertension was detected in 14 patients, their survival at 3 and 5 years was 91 and 73%, respectively.
  
  
  CONCLUSIONS
  Pulmonary thromboendarterectomy offers excellent results in chronic thromboembolic pulmonary hypertension. Long-term survival is good, functional capacity improves, and pulmonary hypertension is resolved in most patients.
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: mjgude@gmail.com.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: López Gude
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez de la Sota
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Forteza Gil
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Jorge
authors.initials: J
authors.lastname: Centeno Rodríguez
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Andrea
authors.initials: A
authors.lastname: Eixerés
authors.affiliation: Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Velázquez
authors.affiliation: Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: María Antonia
authors.initials: MA
authors.lastname: Sánchez Nistal
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Pérez Vela
authors.affiliation: Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: María José
authors.initials: MJ
authors.lastname: Ruiz Cano
authors.affiliation: Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Gómez Sanchez
authors.affiliation: Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Escribano Subías
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: José María
authors.initials: JM
authors.lastname: Cortina Romero
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D002908:Chronic Disease; D004691:Endarterectomy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D007036:Hypothermia, Induced; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D011655:Pulmonary Embolism / Q000150:complications / Q000601:surgery*; D020127:Recovery of Function; D015427:Reperfusion Injury / Q000209:etiology / Q000628:therapy; D012121:Respiration, Artificial; D017131:Thrombectomy / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014655:Vascular Resistance; D055815:Young Adult
keywords: Hipertensión pulmonar; Pulmonary hypertension; Pulmonary thromboembolism; Pulmonary thromboendarterectomy; Tromboembolismo pulmonar; Tromboendarterecterectomía pulmonar