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Anesthesia for Pulmonary Endarterectomy

  • Cara Iorianni
  • Ellen Richter
Chapter

Abstract

Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH), a disease that is increasingly being identified as a complication of acute pulmonary embolism. It is a complex surgical procedure involving the removal of obstructive material (including the intima and superficial media) from the pulmonary vasculature and requires cardiopulmonary bypass along with periods of deep hypothermic circulatory arrest. Complications include reperfusion pulmonary edema, pulmonary arterial steal, and persistent pulmonary hypertension, in addition to those common to other open-heart procedures. While PEA is still considered a high-risk surgery performed by only a small number of experienced medical centers, patient morbidity and mortality has significantly improved over the years. Surgical success is greatly dependent not only on surgical expertise, but also on the perioperative care delivered by an experienced cardiac anesthesiologist. This chapter reviews the pathophysiology of CTEPH as well as the pre-, intra-, and post-operative considerations for the anesthetic management of these patients.

Keywords

Chronic thromboembolic pulmonary hypertension Pulmonary endarterectomy Pulmonary thromboendarterectomy Reperfusion pulmonary edema Pulmonary arterial steal 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyEmory UniversityAtlantaUSA
  2. 2.Division of Cardiothoracic Anesthesiology, Department of AnesthesiologyEmory UniversityAtlantaUSA

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