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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 116-126, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
SW Jamieson, WR Auger, PF Fedullo, RN Channick, JM Kriett, RY Tarazi and KM Moser
A program to alleviate chronic, major vessel thromboembolic pulmonary
hypertension by pulmonary thromboendarterectomy was initiated at this
institution in 1970. Multiple evolutionary changes in the diagnostic
evaluation, surgical approach, and postoperative management have been
implemented over the series of 323 thromboendarterectomies performed
through March 1992. A sequence of five surgeons at the University of
California at San Diego have performed these procedures, with the last 150
having been performed by one surgeon. We report here the changes in
surgical approach developed over the last 150 cases and the results
obtained. The operation involves a median sternotomy incision, the
institution of cardiopulmonary bypass, and deep hypothermia with
circulatory arrest periods. Incisions are made in both pulmonary arteries
into the lower lobe branches. Pulmonary thromboendarterectomy is always
bilateral, with removal of both organized thrombus and an endarterectomy
plane from all involved vessels. The right atrium is routinely explored for
atrial septal defects. Current techniques appear to allow more thorough
revascularization and shorter circulatory arrest times. The surgical
mortality of 8.7% over this span is below that previously reported from
this and other institutions. Among survivors, the hemodynamic and
functional results have been excellent. Surgically correctable chronic
thromboembolic pulmonary hypertension likely remains underdiagnosed. The
diagnostic, surgical, and postoperative management evolution provided by
the coordinated team involved at this institution has established that
pulmonary thromboendarterectomy can be performed with an acceptable risk
and good hemodynamic and symptomatic results.
ARTICLES
Experience and results with 150 pulmonary thromboendarterectomy operations over a 29-month period
Division of Cardiothoracic Surgery, University of California, School of Medicine, San Diego 92103-8892.
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E. J.R. van Beek Thromboembolic Disease : Can Echocardiography Assist Management? Chest, October 1, 2000; 118(4): 888 - 889. [Full Text] [PDF]
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P. Dartevelle, E. Fadel, A. Chapelier, P. Macchiarini, J. Cerrina, F. Parquin, F. Simonneau, and G. Simonneau |
