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Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension

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Diagnosis and Treatment of Pulmonary Hypertension

Abstract

For chronic thromboembolic pulmonary hypertension (CTEPH), well-established and standardized pulmonary endarterectomy (PEA) is still the first-line therapy with the favorable early and late outcome, particularly, for the proximal lesions of CTEPH. Reperfusion lung injury and residual pulmonary hypertension (PH) remain problematic as the complications related to adverse outcome. However, with the recent advancement of PEA including the adequate patients’ selection, the perioperative management, and the technical refinement with accumulation of experiences, the early outcome has been improved with the significant hemodynamic improvement and the lower mortality rates of 5–10 % in general and of less than 5 % in experienced centers. The late outcome is also promising with the low rates of recurrence of CTEPH. On the other hand, an alternative procedure of balloon pulmonary angioplasty (BPA) has been emerging as a less-invasive treatment mainly for difficult patients with inaccessible distal CTEPH lesions and for patients with residual PH after PEA. In these situations, it has been more important to choose the most adequate procedure for each patient and to do, if necessary, the combination therapies of PEA and BPA associated with medical treatments.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Hitoshi Ogino MD, PhD

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  1. Hitoshi Ogino MD, PhD
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Correspondence to Hitoshi Ogino MD, PhD .

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  1. Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan

    Yoshihiro Fukumoto

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Ogino, H. (2017). Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension. In: Fukumoto, Y. (eds) Diagnosis and Treatment of Pulmonary Hypertension. Springer, Singapore. https://doi.org/10.1007/978-981-287-840-3_16

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  • DOI: https://doi.org/10.1007/978-981-287-840-3_16

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