Pulmonary Endarterectomy – The Surgical Treatment of Chronic
Thromboembolic Pulmonary Hypertension
Lindner J., 1Jansa P., 2Kunstýř J., 2Bláha J., Grus T., Mlejnský F., 1Heller S., 1Škvařilová M., 1Ambrož D., Tošovský J., 1Aschermann M., 1Linhart A., 3Křivánek J. 4Vítková I., 2Stříteský M.
II. chirurgická klinika kardiovaskulární chirurgie 1. LF UK a VFN, Praha 1II. interní klinika kardiologie a angiologie 1. LF UK a VFN, Praha 2Klinika anestesiologie, resuscitace a intenzivní mediciny 1. LF UK a VFN, Praha 3Radiodiagnostická klinika 1. LF UK a VFN, Praha 4Ústav patologie 1. LF UK a VFN, Praha
Background. Chronic thromboembolic pulmonary hypertension (CTEPH) in indicated cases can be successfully treated
by the endarterectomy of pulmonary arteries (PEA). Symptomatically not treated CTEPH has highly unfavourable
prognosis. Five years survival of patients with mean pulmonary pressure over 50 mmHg is only 10%. PEA was not
available in the Czech Republic till 2004, when PEA program was initiated it the Cardiocenter of the General teaching
hospital in Prague in collaboration with leading clinics in that field (Prof. Mayer, University of Mainz, BRD).
Methods and results: Up-to-date surgical technique, which in various modifications has been used at majority of
clinics, was elaborated by Jamieson and Daily at University of California in San Diego. It is based on reverse
endarterectomy performed during complete circulatory arrest with brain protection by deep hypothermia. Till
September 2005 twelve patients were operated with zero mortality. In one patient a suture of atrial septum defect was
necessary to perform along. Average time of the circulatory arrest was 45 minutes; duration of the extracorporal
circulation was 334 minutes. Average duration of the operation was 450 minutes. Duration of the mechanical
ventilation was in average 45.5 hours. After one month already haemodynamic parameters (mPA, CI, PVR)
significantly improved or normalized and the average length in the test of six minutes walking increased by 132 meters.
Conclusion: PEA represents a treatment method for patients with CTEPH and surgically accessible pulmonary artery
obstruction. Centralized care of those patients is a rational necessity enabling to get maximum experience with
complicated diagnostics and treatment of those patients. Multidisciplinary collaboration is the essential condition for
the success of the program.
Chronic thromboembolic pulmonary hypertension, pulmonary endarterectomy, circulatory arrest, deep