Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension

David Jenkins, Michael Madani, Elie Fadel, Andrea Maria D'Armini, Eckhard Mayer, David Jenkins, Michael Madani, Elie Fadel, Andrea Maria D'Armini, Eckhard Mayer

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 PEA versus balloon 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.

Conflict of interest statement

Conflict of interest: Disclosures can be found alongside this article at err.ersjournals.com

Copyright ©ERS 2017.

Figures

FIGURE 1
FIGURE 1
Effects of pulmonary vascular resistance (PVR) at diagnosis on in-hospital and 1-year mortality in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary endarterectomy. Data from the international CTEPH registry [23]. *: p1200 dyn·s·cm-5.

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Source: PubMed

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