Pulmonary Thromboendarterectomy In Patients With Chronic Thromboembolic Lung Hypertension And Distal Disease

Introduction and objectives: Chronic thromboembolic pulmonary hypertension is a rare consequence of an acute pulmonary embolism. Pulmonary thromboendarterectomy is the treatment of choice. It represents a greater surgical challenge in distal chronic thromboembolic disease (level III, segmental). It also presents a higher risk of perioperative morbidity and mortality. We analyzed the results of pulmonary thromboendarterectomy in patients with level I-II and level III chronic thromboembolic pulmonary hypertension in our center.Methods: Since February 1996, we have performed 290 consecutive pulmonary thromboendarterectomy, 260 of them with a minimum follow-up of one year (mean of 67 months [rank 17-279]). We divided this population into group 1 (210 patients with chronic thromboembolic pulmonary hypertension levels and H) and group 2 (50 patients with chronic thromboembolic pulmonary hypertension level III [19%]).Results: Survival rate was 94% in group 1 and 96% in group 2 after one year, 93% and 96% after 3 years, and 90% and 96% after 5 years, respectively (P=.352). No statistically significant differences were found regarding hospital mortality (6% vs. 4%, P=.473), perioperative extracorporeal membrane oxigenation (6% vs. 0%, P=.058), the rate of mechanical ventilation for more 48 hours (34 vs. 42%, P=.306) and residual pulmonary hypertension (pulmonary vascular resistance greater than 400 dynes/sec/cm -5 ) at 6 months of follow-up (22% vs. 19%, P=.680).Conclusions: Pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension with distal involvement, when performed in an expert center, can obtain short-to-medium-term results excellent and similar to those of patients operated on with more proximal involvement. (C) 2020 Sociedad Espafiola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U.