Pulmonary thromboendarterectomy is a surgery used to treat chronic thromboembolic pulmonary hypertension. It’s the treatment of choice for this condition.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare type of pulmonary hypertension. Pulmonary hypertension happens when blood pressure in the arteries between the lungs and the heart is too high.
In CTEPH, chronic blood clots have caused pulmonary arteries to narrow or become blocked. This leads to pulmonary hypertension and, if left untreated, can cause heart failure and death.
The main treatment for CTEPH is a surgical procedure called pulmonary thromboendarterectomy. This article reviews this procedure, including when it’s recommended and what to expect.
Pulmonary thromboendarterectomy (PTE) is a surgical treatment for CTEPH. You may also see this surgery called a pulmonary endarterectomy (PEA).
During a PTE, a surgeon carefully removes the blood clots from the arteries in your lungs. This helps open the pulmonary arteries again.
The goals of PTE are to:
- ease or eliminate pulmonary hypertension, which helps reduce the strain on your heart
- alleviate V/Q mismatch, which can lead to low oxygen levels in your blood
- prevent further changes to the structure of the pulmonary arteries
PTE is the
After your doctor diagnoses CTEPH, they will check to see whether you’re a candidate for PTE. Some of the factors they’ll take into consideration include:
- the severity of your symptoms
- the severity of your CTEPH
- whether you have signs of heart failure
- the location and extent of the blood clots in your pulmonary arteries
- if you have any other medical conditions that could make having surgery more risky
Generally,
- CTEPH that’s causing significant issues with their lungs and heart
- blood clots that can be safely and readily accessed with surgical instruments
- minimal underlying medical conditions that could lead to complications
Between
People who don’t have PTE can receive treatment through other methods, including:
- medications that help open the pulmonary arteries
- balloon pulmonary angioplasty (BPA), a minimally invasive procedure that uses a tiny balloon to push your pulmonary arteries open
A PTE is done in a hospital under general anesthesia. You’ll be asleep while under general anesthesia, which means you won’t feel any pain or discomfort during your procedure.
Completing a PTE
- Your surgeon makes an incision in the wall of your chest so they can reach your lungs and heart.
- They stop your heart and connect your body to a heart-lung bypass machine to allow blood to continue to circulate in your body.
- Your body is cooled to lower your need for oxygen and protect your organs during surgery.
- Your surgeon opens the arteries where narrowing or blockages have been found.
- To remove the blood clots, your surgeon stops the heart-lung bypass machine for 20-minute periods to drain the blood from your pulmonary arteries and heart.
- During this time, they carefully peel away the clot tissue lining your pulmonary arteries.
- Steps 5 and 6 are repeated until all of the clots are removed.
- Once the clots are removed, your body temperature is returned to normal and the heart-lung bypass machine is removed. Your surgeon closes the incision in your chest.
After your incision is closed, you’re taken to a recovery room in the hospital’s intensive care unit (ICU). During this time, hospital staff monitor your vital signs as you come out of general anesthesia.
PTE is a major operation. Because of this, you need to stay in the hospital for a while. One
After a PTE, you can typically start returning to your usual activity over the course of 4 to 6 weeks. Most people find they can do normal or close to normal levels of activity 3 to 6 months after an uncomplicated PTE.
Your doctor will want to have follow-up visits to check on how you’re doing. During this time, they may do things like:
- check for signs of surgical complications
- assess your pulmonary blood pressure using right heart catheterization
- gauge the flow of air and blood in your lungs through a ventilation/perfusion (V/Q) scan
- do an echocardiogram to look at your heart and pulmonary arteries
- evaluate your exercise capacity, such as through the 6-minute walk test
Pulmonary rehabilitation may also be beneficial for people who have had a PTE. This is a supervised program that aims to help you breathe better and boost your quality of life. It can include
- breathing techniques
- exercise
- nutritional and psychological counseling
- education
If you’ve had a PTE, you’ll also need to take blood thinners for the rest of your life. These medications can reduce your risk of having more blood clots.
As with any surgery, there are complications and risks associated with PTE. These include:
- a reaction to the general anesthesia
- excessive bleeding
- infections
- pulmonary edema, a buildup of fluid in the lungs
- pericardial effusion, an accumulation of fluid in the sac that surrounds the heart
- arrhythmias
- stroke
It’s also possible for pulmonary hypertension to persist even after PTE. Researchers estimate this happens in around
Before your PTE, your doctor will inform you about the potential risks and complications of your surgery. Be sure to raise any questions and concerns that you may have during this time.
The outlook for people having a PTE is typically very good. A
- symptoms
- pulmonary hypertension parameters
- heart function
- exercise capacity
A
The outlook for people who have had a PTE is improved over people who cannot or choose not to have it. A
| PTE | No PTE | |
|---|---|---|
| Survival rate after 1 year | 93% | 88% |
| Survival rate after 2 years | 91% | 79% |
| Survival rate after 3 years | 89% | 70% |
Researchers also identified factors associated with an increased risk of death in people receiving PTE. These included:
- therapy with pulmonary arterial hypertension (PAH) drugs before PTE
- complications during or after PTE
- persistent pulmonary hypertension after PTE
- the need for additional procedures on the heart
- kidney disease that requires dialysis
PTE can also improve the quality of life for people with CTEPH. A
PTE is the treatment of choice for CTEPH. It’s a major surgery in which a surgeon removes the blood clots that are contributing to pulmonary hypertension.
Although potentially serious complications are possible, the outlook for people having PTE is generally quite good. Individuals having an uncomplicated PTE procedure tend to have improved survival over those who don’t have PTE.
Not everyone is eligible to have PTE. If you’ve recently received a CTEPH diagnosis, talk with your doctor about what PTE entails and whether you’d be a candidate.