Title:Surgical Treatment of Pulmonary Embolism and Chronic Thromboembolic
Pulmonary Hypertension
Volume: 28
Issue: 7
Author(s): Nikolaos A. Papakonstantinou*, Polydoros N. Kampaktsis, Filippos-Paschalis Rorris, Ilias Doulamis, Aspasia Tzani, Sotirios Katsaridis and Dimitrios Avgerinos
Affiliation:
- Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
Keywords:
Pulmonary embolism, chronic thromboembolic pulmonary hypertension, pulmonary hypertension, pulmonary endarterectomy, embolectomy, right heart failure.
Abstract: Venous thromboembolism clinically presents as deep venous thrombosis or acute pulmonary embolism
and is globally recognized as the third most frequent acute cardiovascular syndrome after myocardial infarction
and stroke. Although pulmonary embolism does not typically cause severe pulmonary hypertension in
the acute setting, thrombus organization and fibrosis can lead to stenosis or obliteration of pulmonary arteries in
a minority of patients, which in turn result in severe pulmonary hypertension and right heart failure. This disease
is labeled chronic thromboembolic pulmonary hypertension and can occur after a single episode or multiple
ones of pulmonary embolism. The cornerstone of pulmonary embolism treatment is medical therapy,
whereas systemic thrombolytic therapy has to be considered for patients with hemodynamic instability. Given
the current acceptable short-term surgical mortality, the potential of first-line surgical embolectomy as an alternative
to medical thrombolysis has gained momentum as far as pulmonary embolism treatment is concerned. In
contrast to pulmonary embolism, bilateral complete pulmonary endarterectomy under short deep hypothermic
circulatory arrest intervals is the treatment of choice against chronic thromboembolic pulmonary hypertension,
given patients’ operability. Pulmonary endarterectomy is suggested in every operable patient when the operation
is offered by an experienced multidisciplinary team, including at least one experienced surgeon. Surgical
embolectomy should also be limited to large institutions since it also requires an experienced heart team. This
review concerns a thorough discussion regarding surgical treatment of pulmonary embolism and chronic thromboembolic
pulmonary hypertension. Eligibility criteria, operation-related complications and postoperative outcomes
are discussed in detail.
