• Can J Cardiol · Nov 2011

    Comparative Study

    Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: the Toronto experience.

    • Marc de Perrot, Karen McRae, Yaron Shargall, Laura Pletsch, Kongteng Tan, Peter Slinger, Martin Ma, Narinder Paul, Jakov Moric, John Thenganatt, Susanna Mak, and John T Granton.
    • Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. marc.deperrot@uhn.on.ca
    • Can J Cardiol. 2011 Nov 1; 27 (6): 692-7.

    BackgroundPulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (PH). However, this surgery remains performed in few experienced centres only. The goal of the study is to review our overall experience since the implementation of our program in August 2005.MethodsReview all patients referred to our program between August 2005 and July 2011.ResultsAmong 84 consecutive patients referred to our program, 52 patients underwent elective PEA and 6 emergency PEA. After PEA, 74% patients were extubated within 2 days, 71% were discharged from the intensive care unit within 4 days and 64% were discharged from hospital within 15 days. One patient undergoing elective surgery and 2 patients undergoing emergency surgery died within 30 days of surgery for an operative mortality of 1.9% after elective pulmonary endarterectomy and an overall operative mortality of 5.2%, when the 6 emergency operative cases were included. The total pulmonary vascular resistance decreased from 965±445 to 383±162 dynes per second per cm(-5) and was associated with significant improvement in World Health Organization/New York Heart Association (WHO/NYHA) functional class, 6 minutes walk distance, echocardiographic findings, and brain natriuretic peptide level at 6 months after PEA. After a median follow-up of 23 months (1-65 months), 3 patients had to be started on targeted PH therapy for deterioration of their (WHO/NYHA) functional class.ConclusionsElective PEA can be performed with limited risk, and results in excellent early and long-term outcome. All patients diagnosed with chronic thromboembolic PH should be referred for consideration of PEA in a specialized centre.Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

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