Mid-term results of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension

Ann Thorac Surg. 1996 Jun;61(6):1788-92. doi: 10.1016/0003-4975(96)00169-5.


Background: In patients with chronic thromboembolic pulmonary hypertension, acute and striking decreases of pulmonary artery pressures and vascular resistance can be achieved by pulmonary thromboendarterectomy. In this study, the long-term effects of pulmonary thromboendarterectomy on hemodynamic indices and right ventricular function were investigated.

Methods: Sixty-five patients (31 women and 34 men; mean age, 47 +/- 17 years; range, 19 to 69 years; New York Heart Association [NYHA] functional class II, n = 3; class III, n = 38; class IV, n = 24) were reassessed 13 to 48 months (mean, 27 months) after pulmonary thromboendarterectomy. Measurements are reported as mean +/- standard deviation.

Results: All patients reported a significant improvement of symptoms: 46 patients were in NYHA functional class I, 16 patients in class II, and 3 patients in class III. Mean pulmonary vascular resistance was significantly reduced compared with preoperative and postoperative values (preoperative: 1,015 +/- 454 dynes.s.cm-5; postoperative: 322 +/- 154 dynes.s.cm-5; follow-up: 198 +/- 72 dynes.s.cm-5; p < 0.001 versus preoperative; p < 0.025 versus postoperative). Concomitantly, cardiac index was significantly increased compared with preoperative values (preoperative: 2.0 +/- 0.7 L.min-1.m-2; follow-up: 2.9 +/- 0.5 L.min-1.m-2; p < 0.001). Significant reductions of right ventricular dimensions and recovery of right ventricular function could be demonstrated radiologically and echocardiographically. In 3 patients (preoperative NYHA class IV, NYHA class III at follow-up) with proven coagulation abnormalities, pulmonary vascular resistance was moderately increased at follow-up compared with postoperative measurements.

Conclusions: In patients with chronic thromboembolic pulmonary hypertension, a persistent decrease of pulmonary vascular resistance and improvement of right ventricular function and NYHA functional status can be achieved by pulmonary thromboendarterectomy.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Angiography, Digital Subtraction
  • Blood Coagulation Disorders / complications
  • Blood Coagulation Disorders / physiopathology
  • Cardiac Output
  • Catheterization, Swan-Ganz
  • Chronic Disease
  • Echocardiography
  • Endarterectomy*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension, Pulmonary / surgery*
  • Male
  • Middle Aged
  • Pulmonary Artery / diagnostic imaging
  • Pulmonary Artery / surgery
  • Pulmonary Wedge Pressure
  • Thrombectomy*
  • Thromboembolism / complications
  • Vascular Resistance
  • Ventricular Function, Right