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Ann Thorac Surg 2003;76:1457-1464
© 2003 The Society of Thoracic Surgeons

J. Maxwell Chamberlain Memorial Paper

Pulmonary endarterectomy: experience and lessons learned in 1,500 cases

Stuart W. Jamieson, MB, FRCSa*, David P. Kapelanski, MDa, Naohide Sakakibara, MDa, Gerard R. Manecke, MDb, Patricia A. Thistlethwaite, MD, PhDa, Kim M. Kerr, MDc, Richard N. Channick, MDc, Peter F. Fedullo, MDc, William R. Auger, MDc

a Division of Cardiothoracic Surgery, San Diego, California, USA
b Department of Anesthesia, San Diego, California, USA
c Division of Pulmonary and Critical Care Medicine, UCSD Medical Center, San Diego, California, USA

* Address reprint requests to Mr Jamieson, Cardiothoracic Surgery, UCSD Medical Center, 200 West Arbor Drive, San Diego, CA 92103, USA.
e-mail: sjamieson{at}ucsd.edu

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.

Abstract

BACKGROUND: The incidence of pulmonary hypertension resulting from chronic thrombotic occlusion of the pulmonary arteries is significantly underestimated. Although medical therapy for the condition is supportive only, surgical therapy is curative. Our pulmonary endarterectomy program was begun in 1970, and 188 patients were operated on in the subsequent 20 years. With the increased recognition of the disease and the success of operative therapy, however, more than 1,400 operations have been done since 1990 at our center.

METHODS: The safety and efficacy of the operation was assessed with changes made through increased experience. We examined in detail the results of our last 500 consecutive patients.

RESULTS: Median sternotomy, cardiopulmonary bypass, profound hypothermia, and circulatory arrest were found to be essential to the success of the operation. All occluding material could be removed at operation. We currently believe that there is no degree of embolic occlusion within the pulmonary vascular tree that is inaccessible and no degree of right ventricular impairment or any level of pulmonary vascular resistance that is inoperable. With shorter cardiac arrest periods and the use of a cooling jacket to the head, cerebral impairment has been eliminated. The pulmonary artery pressures and pulmonary vascular resistance in a recent cohort of 500 patients is examined. The mortality rate for the operation has been reduced steadily, and was 22 of the last 500 patients operated on (4.4%).

CONCLUSIONS: The operation is considered curative and therefore greatly superior to transplantation for this condition. Current techniques of operation make the procedure relatively safe.




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 Eur Respir JHome page
R. J. Hughes, X. Jais, D. Bonderman, J. Suntharalingam, M. Humbert, I. Lang, G. Simonneau, and J. Pepke-Zaba
The efficacy of bosentan in inoperable chronic thromboembolic pulmonary hypertension: a 1-year follow-up study
Eur. Respir. J., July 1, 2006; 28(1): 138 - 143.
[Abstract] [Full Text] [PDF]

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 Mayo Clin Proc.Home page
G. Casaclang-Verzosa, R. B. McCully, J. K. Oh, F. A. Miller Jr, and C. G. A. McGregor
Effects of Pulmonary Thromboendarterectomy on Right-Sided Echocardiographic Parameters in Patients With Chronic Thromboembolic Pulmonary Hypertension
Mayo Clin. Proc., June 1, 2006; 81(6): 777 - 782.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
P. A. Thistlethwaite, A. Kemp, L. Du, M. M. Madani, and S. W. Jamieson
Outcomes of pulmonary endarterectomy for treatment of extreme thromboembolic pulmonary hypertension
J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 307 - 313.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. S. Sachweh, S. H. Daebritz, B. Hermanns, B. Fausten, S. Jockenhoevel, S. Handt, and B. J. Messmer
Hypertensive Pulmonary Vascular Disease in Adults with Secundum or Sinus Venosus Atrial Septal Defect
Ann. Thorac. Surg., January 1, 2006; 81(1): 207 - 213.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
T. Kramm, B. Eberle, S. Guth, and E. Mayer
Inhaled iloprost to control residual pulmonary hypertension following pulmonary endarterectomy
Eur. J. Cardiothorac. Surg., December 1, 2005; 28(6): 882 - 888.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
F. Langer, M. Bauer, D. Tscholl, R. Schramm, T. Kunihara, H. Lausberg, T. Georg, H. Wilkens, and H.-J. Schafers
Circulating big endothelin-1: An active role in pulmonary thromboendarterectomy?
J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1342 - 1347.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
J. H. Newman
Pulmonary Hypertension
Am. J. Respir. Crit. Care Med., November 1, 2005; 172(9): 1072 - 1077.
[Abstract] [Full Text] [PDF]

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 ChestHome page
M. M. Hoeper, T. Kramm, H. Wilkens, C. Schulze, H. J. Schafers, T. Welte, and E. Mayer
Bosentan Therapy for Inoperable Chronic Thromboembolic Pulmonary Hypertension
Chest, October 1, 2005; 128(4): 2363 - 2367.
[Abstract] [Full Text] [PDF]

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 SEMIN CARDIOTHORAC VASC ANESTHHome page
G. R. Manecke Jr, W. C. Wilson, W. R. Auger, and S. W. Jamieson
Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Thromboendarterectomy
Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2005; 9(3): 189 - 204.
[Abstract] [PDF]

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 RadiologyHome page
K. Nikolaou, S. O. Schoenberg, U. Attenberger, J. Scheidler, O. Dietrich, B. Kuehn, F. Rosa, A. Huber, H. Leuchte, R. Baumgartner, et al.
Pulmonary Arterial Hypertension: Diagnosis with Fast Perfusion MR Imaging and High-Spatial-Resolution MR Angiography--Preliminary Experience
Radiology, August 1, 2005; 236(2): 694 - 703.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
G. Ramakrishna, J. Sprung, B. S. Ravi, K. Chandrasekaran, and M. D. McGoon
Impact of Pulmonary Hypertension on the Outcomes of Noncardiac Surgery: Predictors of Perioperative Morbidity and Mortality
J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1691 - 1699.
[Abstract] [Full Text] [PDF]

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 ChestHome page
M. Heinrich, M. Uder, D. Tscholl, A. Grgic, B. Kramann, and H.-J. Schafers
CT Scan Findings in Chronic Thromboembolic Pulmonary Hypertension: Predictors of Hemodynamic Improvement After Pulmonary Thromboendarterectomy
Chest, May 1, 2005; 127(5): 1606 - 1613.
[Abstract] [Full Text] [PDF]

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 PerfusionHome page
L. Puis, E. Vandezande, L. Vercaemst, P. Janssens, Y. Taverniers, M. Foulon, R. Demeyere, M. Delcroix, and W. Daenen
Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension
Perfusion, March 1, 2005; 20(2): 101 - 108.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
P. Rosenberger, S. K. Shernan, T. Mihaljevic, and H. K. Eltzschig
Transesophageal echocardiography for detecting extrapulmonary thrombi during pulmonary embolectomy
Ann. Thorac. Surg., September 1, 2004; 78(3): 862 - 866.
[Abstract] [Full Text] [PDF]

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 Anesth. Analg.Home page
G. R. Manecke Jr., A. Kotzur, G. Atkins, P. F. Fedullo, W. R. Auger, D. P. Kapelanski, and S. W. Jamieson
Massive Pulmonary Hemorrhage After Pulmonary Thromboendarterectomy
Anesth. Analg., September 1, 2004; 99(3): 672 - 675.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
G. Simonneau, N. Galie, L. J. Rubin, D. Langleben, W. Seeger, G. Domenighetti, S. Gibbs, D. Lebrec, R. Speich, M. Beghetti, et al.
Clinical classification of pulmonary hypertension
J. Am. Coll. Cardiol., June 16, 2004; 43(12_Suppl_S): 5S - 12S.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
W. Klepetko, E. Mayer, J. Sandoval, E. P. Trulock, J.-L. Vachiery, P. Dartevelle, J. Pepke-Zaba, S. W. Jamieson, I. Lang, and P. Corris
Interventional and surgical modalities of treatment for pulmonary arterial hypertension
J. Am. Coll. Cardiol., June 16, 2004; 43(12_Suppl_S): 73S - 80S.
[Abstract] [Full Text] [PDF]

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 NEJMHome page
I. M. Lang
Chronic Thromboembolic Pulmonary Hypertension -- Not So Rare after All
N. Engl. J. Med., May 27, 2004; 350(22): 2236 - 2238.
[Full Text] [PDF]


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