Chronic pulmonary thromboembolic disease (cPE) results in significant morbidity and mortality. Surgical therapy is aimed at alleviating the effects of the thrombus on oxygen saturation, pulmonary hypertension, and improving outcomes. This study was conducted to determine our experience with pulmonary thromboembolectomy as a therapy for cPE.
A retrospective chart review identified patients undergoing pulmonary endarterectomy for chronic pulmonary thromboembolism. We obtained demographics, symptoms prior to surgical therapy, operative procedures, and outcomes.
Between December 1994 and December 2003 a total of 30 patients were surgically treated for chronic pulmonary embolism. There were 13 males and 17 females. Average age was 49.2 yrs (range 21- 76 yrs). The most common presenting symptom was SOB in 26 (96.7%) patients. Half the patients (50%) had a past medical history of venous thromboembolic disease, 20% had a documented hypercoagulable state, but 93.3% of the patients had a vena cava filter placed preoperatively. Mean preoperative systolic pulmonary artery presssures (PAP) was 77.9 mmHg (range 53 –107 mmHg). Surgical approaches included bilateral thromboembolectomies in 25 (83.3%) patients. Circulatory arrest was used in 29 (97%. Mean arrest time of 33.2 minutes (range 6 –60 minutes). Postoperatively there was a decrease in mean systolic PAP to 41.4 mmHg (range 26-73 mmHg, p < 0.001). While mean saturations (SAT) increased following surgical intervention (pre op SAT 94.2% vs. post op SAT 96.1%, p = 0.014) this did not result in a decrease in supplemental oxygen use. The 30 day survival was 93.3 % with an overall survival of 80.3% (mean follow-up of 3.5 yrs, range 7d - 10.3 years).
Pulmonary thromboembolectomy under circulatory arrest is a safe and effective intervention which significantly improves pulmonary artery pressures, oxygen saturation and is associated with good mid-term outcomes.
Pulmonary thromboembolectomy is an effective means of therapy for patients suffering of disabiling pulmonary symptoms as a result of chronic pulmonary thromboembolic disease.
Gonzalo Gonzalez-Stawinski, None.