title: Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension.
abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension, resulting from fibrotic transformation of pulmonary artery clots causing chronic obstruction in macroscopic pulmonary arteries and associated vascular remodelling in the microvasculature.Pulmonary endarterectomy (PEA) offers the best chance of symptomatic and prognostic improvement in eligible patients; in expert centres, it has excellent results. Current in-hospital mortality rates are <5% and survival is >90% at 1 year and >70% at 10 years. However, PEA, is a complex procedure and relies on a multidisciplinary CTEPH team led by an experienced surgeon to decide on an individual's operability, which is determined primarily by lesion location and the haemodynamic parameters. Therefore, treatment of patients with CTEPH depends largely on subjective judgements of eligibility for surgery by the CTEPH team.Other controversies discussed in this article include eligibility for PEAversusballoon pulmonary angioplasty, the new treatment algorithm in the European Society of Cardiology/European Respiratory Society guidelines and the definition of an "expert centre" for the management of this condition.
authors.affiliation: Dept of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK david.jenkins1@nhs.net.
authors.forename: David
authors.initials: D
authors.lastname: Jenkins
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Madani
authors.affiliation: Hôpital Marie Lannelongue and Université Paris-Sud, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Fadel
authors.affiliation: Dept of Cardio-Thoracic and Vascular Surgery, Heart and Lung Transplantation and Pulmonary Hypertension Unit, Foundation IRCCS Policlinico San Matteo, University of Pavia School of Medicine, Pavia, Italy.
authors.forename: Andrea Maria
authors.initials: AM
authors.lastname: D'Armini
authors.affiliation: Kerckhoff Heart and Lung Center, Bad Nauheim, Germany.
authors.forename: Eckhard
authors.initials: E
authors.lastname: Mayer
mesh_terms: D002908:Chronic Disease; D004691:Endarterectomy / Q000009:adverse effects / Q000401:mortality; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D011655:Pulmonary Embolism / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome