Pulmonary endarterectomy: is there an alternative to profound hypothermia with cardiocirculatory arrest?

Mikuš, Petr; Dell’Amore, Andrea; Pastore, S.; Galiè, Nazzareno

doi:10.1016/j.ejcts.2006.06.016

Cited by 14 publications

(4 citation statements)

References 3 publications

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“…As the procedure is conducted on beating heart with CPB support, we negate the need of complex cannulation of the aortic arch vessels for selective antegrade cerebral perfusion for PTE [ 11 - 13 ] . Our method of PTE differs from the method described by Mikus et al [ 14 ] in the fact that we use extensive venting of the left atrium via the RSPV, the right ventricle, the contralateral PA, and do not arrest the heart. We, however, follow a strategy of blood conservation similar to the described by the author by using a negative suction dissector connected to a cell saver.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Thromboendarterectomy Without Circulatory Arrest

Kynta¹,

Rawat²,

Mandal³

et al. 2022

Braz J Cardiovasc Surg

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Introduction Here we describe our technique and results of beating heart pulmonary thromboendarterectomy (PTE) with cardiopulmonary bypass (CPB) in four patients for treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Methods Retrospective analysis of data from patients who underwent PTE for CTEPH between January 2019 and September 2020. Patients were followed up with clinical assessment, 2D echocardiography, and computed tomography pulmonary angiogram. Results Four patients were operated for CTEPH using our technique. Moderate tricuspid regurgitation (TR) and severe TR were found in two patients each. Severe right ventricular (RV) dysfunction was found in all cases. Thrombi were classified as Jamieson type II in three cases and type I in one case. Postoperative median direct manometric pulmonary artery (PA) pressures decreased (from 46.5 mmHg to 23.5 mmHg), median CPB time was 126 minutes, and median temperature was 33.35 °C. Mechanical ventilation was for a median of 19.5 hours. There was one re-exploration. Median intensive care unit stay was 7.5 days. There was no mortality. Postoperative 2D echocardiography revealed decrease in median PA systolic pressures (from 85 mmHg to 33 mmHg), improvement in RV function by tricuspid annular plane systolic excursion (median 14 mm vs . 16 mm), and improved postoperative oxygen saturations (88.5% vs . 99%). In follow-up (ranging between 2-15 months), all patients reported improvement in quality of life and were in New York Heart Association class I. Conclusion With our described simple modifications, advances in perfusion, and blood conservation technologies, one can avoid the need for deep hypothermic circulatory arrest during PTE.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Thromboendarterectomy Without Circulatory Arrest

Kynta¹,

Rawat²,

Mandal³

et al. 2022

Braz J Cardiovasc Surg

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“…At a very low pump flows, the back flow can be as scarce as in arrest, allowing a complete endarterectomy. The main disadvantage of this method and in an unpredictable manner (perhaps the extent of collateral bronchial circle could serve as an indicator) in spite of a minimum pump flow, the retrograde flow is making it impossible to impose endarterectomy (6,7). This constrains to go back to pump full flow to reach 20 degrees of temperature and proceed with the DHCA, prolonging in these cases the extracorporeal circulation (CPB) and aortic cross-clamping times.…”

Section: Methodsmentioning

confidence: 99%

Pulmonary thrombo-endarterectomy for chronic thromboembolic pulmonary artery hypertension

Martìn-Suàrez¹,

Gliozzi²,

Loforte³

et al. 2021

Curr Chall Thorac Surg

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Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is the only type of pulmonary hypertension (PH) with a surgical treatment aimed to remove fibrotic thrombus allowing a significant lowering of pulmonary vascular resistances (PVR) or even normalisation of PH. Pulmonary thromboendarterectomy (PTE) is performed through full median sternotomy, cardiopulmonary bypass (CPB) with periods of deep hypothermic circulatory arrest (DHCA). Diagnostic process, patient selection, surgical and postoperative management require specific expertise and a multidisciplinary team as we have in our department. In the present paper we will expose our single-center 17-year retrospective experience on PTE.Methods: We present a cohort of 177 consecutive PTE patients underwent surgery in two different "Eras": groups 1 and 2, with 96 and 81 patients respectively. During the first period (2003 to 2012) DHCA was applied strictly if venous pulmonary back-bleeding precluded a complete endarterectomy, while during the second era [2012][2013][2014][2015][2016][2017][2018][2019][2020] DHCA was routinely adopted during CPB. Retrospective analysis of preoperative data, as well as surgical characteristics and postoperative outcome have been compared between groups.Results: Some differences on preoperative clinical and hemodynamic data have been found, as the incidence of concomitant chronic pulmonary disease and more decompensated profile in the first group. On the other hand, in group 2, a larger number of patients were preoperatively treated with specific pulmonary vasodilators. Cross clamp time as well as time of CPB were significantly shorter in group 2 in spite of a mean DHCA time of 33 minutes. In-hospital mortality was 15.6% and 3.7%, in groups 1 and 2 respectively. Pulmonary hemodynamic as well as long term outcome equally and significantly improved in both groups.Conclusions: Our experience demonstrates that, as in other fields of cardio-thoracic surgery, learning curve strongly impact on results: multidisciplinary preoperative evaluation and selection of patients, surgical planning and well-defined intra-and post-operative protocols contribute to improve hemodinamics and clinical outcomes. This assertion acquires more sense since this pathology is considered a rare one, requiring deep knowledge on its pathophysiology, diagnostic procedures, therapeutic alternatives, as well as specific skills on surgical and anaesthetic management. Our CTEPH center offers all the needed pathway, from diagnostic to therapeutic alternatives, with excellent results.

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“…Отже, мультидисциплінарна команда, коли оцінює операбельність хворого, має враховувати не тільки технічну можливість проведення операції, але й вірогідність ускладнень та можливу користь для пацієнта, покращання його якості життя. Тому всіх пацієнтів умовно поділяють на 1) «операбельні» -ЛТЕА провести технічно можна (проксимальне ураження), загальний стан пацієнта дозволяє це зробити, ризик ускладнень малий; 2) «технічно операбельні», але ЛТЕА асоціюється з високими ризиками ускладнень та смерті; 3) «технічно неоперабельні» -провести ЛТЕА не можна [28]. Для категорій 2 та 3 існує також можливість провести внутрішньосудинну ангіопластику легеневих артерій, якої, на жаль, в Україні не проводять у жодному центрі.…”

Section: що відомо про хронічну тромбоемболічну легеневу гіпертензію?unclassified

Chronic thromboembolic pulmonary hypertension: clinical case and problem review

Radchenko,

Torbas,

Sirenko

2023

UJC

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In this article there was presented a clinical case of the chronic thromboembolic pulmonary hypertension (CTEPH) in the patient with small arteries damage. The thromb visualization was done by the lung perfusion multispiral computer tomography. The general positions of the definition, the diagnosis and treatment of the CTEPH were elucidated too. It was stated the CTEPH is a potential curable disease in case of the surgery in time. But there are some situations when it is not possible to provide the surgery and, in this case, the CTEPH treatment by specific pulmonary hypertension drugs could be used

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Pulmonary endarterectomy: is there an alternative to profound hypothermia with cardiocirculatory arrest?

Cited by 14 publications

References 3 publications

Pulmonary Thromboendarterectomy Without Circulatory Arrest

Pulmonary Thromboendarterectomy Without Circulatory Arrest

Pulmonary thrombo-endarterectomy for chronic thromboembolic pulmonary artery hypertension

Chronic thromboembolic pulmonary hypertension: clinical case and problem review

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