Pulmonary endarterectomy: The treatment of choice for chronic thromboembolic pulmonary hypertension

A percentage ranging from 0.1 to 4.0 of patients recovering from acute pulmonary embolism develop chronic thromboembolic pulmonary hypertension (CTEPH). Without intervention, CTEPH is a progressive and lethal disease for which there is no effective medical therapy. Pulmonary endarterectomy (PEA) is the treatment of choice. Lung transplantation is indicated only in few cases when PEA is not feasible. Since 1994 at the IRCCS San Matteo Hospital - University of Pavia (Italy), 134 PEAs have been performed. Preoperatively, NYHA class distribution was respectively 3-II, 56-III, and 75-IV; mean pulmonary artery pressure and pulmonary vascular resistances were 47 ± 13 mmHg and 1149 ± 535 dynes*s*cm^-5 respectively. The overall operative mortality has been 9.7% (4.5% in 2004). Survival at 3-month, 1-year, and 3-year follow-up was 89.5 ± 2.6, 87.8 ± 2.9, and 83.3 ± 3.5% respectively; this last rate was unchanged up to 10 years. After PEA, mean pulmonary artery pressure and pulmonary vascular resistances were 25 ± 9 mmHg and 322 ± 229 dynes*s*cm^-5 respectively and these results were stable over time. At the 3-year follow-up, 94% of patients were in NYHA class I or II and the only therapy is anticoagulation.