Abstract
Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is primarily managed by pulmonary
thromboendarterectomy (PTE). As advanced surgical techniques permit resection at the
segmental and subsegmental level, PTE can now be curative for CTEPH mostly involving
the distal pulmonary arteries.
Methods
Between January 2017 and June 2021, consecutive patients undergoing PTE were categorized
according to the most proximal level of chronic thrombus resection: Level I (main
pulmonary artery), Level II (lobar), Level III (segmental) and Level IV (subsegmental).
Proximal disease patients (any Level I or II) were compared to distal disease (Level
III or IV bilaterally) patients. Demographics, medical history, preoperative pulmonary
hemodynamics, and immediate postoperative outcomes were obtained for each group.
Results
During the study period, 794 patients underwent PTE, 563 with proximal disease and
231 with distal disease. Patients with distal disease more frequently had a history
of an indwelling intravenous device, splenectomy, upper extremity thrombosis or use
thyroid replacement and less often had prior lower extremity thrombosis or hypercoagulable
state. Despite more use of PAH-targeted medications in the distal disease group (63.2%
vs. 50.1%, p<0.001), pre-operative hemodynamics were similar. Both patient groups
exhibited significant improvements in pulmonary hemodynamics postoperatively with
comparable in-hospital mortality rates. Compared to proximal disease, a lower percentage
of patients with distal disease showed residual pulmonary hypertension (3.1% vs. 6.9%,
p=0.039) and airway hemorrhage (3.0% vs. 6.6%, p=0.047) post-operatively.
Conclusions
Thromboendarterectomy for distal (segmental and subsegmental) CTEPH is technically
feasible and may result in favorable pulmonary hemodynamic outcomes, without increased
mortality or morbidity
Keywords
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