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Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension
Pulmonary endarterectomy (PEA) is the treatment of choice to relieve pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH). It is a complex surgical procedure with a simple principle: removal of obstructive thromboembolic material from the pulmonary arte...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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European Respiratory Society
2015
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9487822/ https://www.ncbi.nlm.nih.gov/pubmed/26028638 http://dx.doi.org/10.1183/16000617.00000815 |
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author | Jenkins, David |
author_facet | Jenkins, David |
author_sort | Jenkins, David |
collection | PubMed |
description | Pulmonary endarterectomy (PEA) is the treatment of choice to relieve pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH). It is a complex surgical procedure with a simple principle: removal of obstructive thromboembolic material from the pulmonary arteries in order to reduce pulmonary vascular resistance, relieve pulmonary hypertension (PH) and alleviate right ventricular dysfunction. In the majority of patients there is symptomatic and prognostic benefit. However, not all patients with CTEPH are suitable for treatment with PEA. Operability assessment is not always easy, being largely subjective and based on experience. It is therefore important that all patients are referred to an experienced CTEPH centre for careful evaluation of suitability for surgery. The most common reason for inoperability is distal vasculopathy accounting for a high proportion of the vascular resistance. Surgery requires cardiopulmonary bypass and periods of deep hypothermic circulatory arrest. Complications include reperfusion lung injury and persistent PH. However, with careful patient selection, surgical technique and post-operative management, PEA is a highly effective treatment with mortality rates <5% at experienced centres. Patients who are unsuitable for surgery may be candidates for medical therapy. |
format | Online Article Text |
id | pubmed-9487822 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-94878222022-11-14 Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension Jenkins, David Eur Respir Rev Reviews Pulmonary endarterectomy (PEA) is the treatment of choice to relieve pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH). It is a complex surgical procedure with a simple principle: removal of obstructive thromboembolic material from the pulmonary arteries in order to reduce pulmonary vascular resistance, relieve pulmonary hypertension (PH) and alleviate right ventricular dysfunction. In the majority of patients there is symptomatic and prognostic benefit. However, not all patients with CTEPH are suitable for treatment with PEA. Operability assessment is not always easy, being largely subjective and based on experience. It is therefore important that all patients are referred to an experienced CTEPH centre for careful evaluation of suitability for surgery. The most common reason for inoperability is distal vasculopathy accounting for a high proportion of the vascular resistance. Surgery requires cardiopulmonary bypass and periods of deep hypothermic circulatory arrest. Complications include reperfusion lung injury and persistent PH. However, with careful patient selection, surgical technique and post-operative management, PEA is a highly effective treatment with mortality rates <5% at experienced centres. Patients who are unsuitable for surgery may be candidates for medical therapy. European Respiratory Society 2015-06 /pmc/articles/PMC9487822/ /pubmed/26028638 http://dx.doi.org/10.1183/16000617.00000815 Text en Copyright ©ERS 2015. https://creativecommons.org/licenses/by-nc/4.0/ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. |
spellingShingle | Reviews Jenkins, David Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension |
title | Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension |
title_full | Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension |
title_fullStr | Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension |
title_full_unstemmed | Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension |
title_short | Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension |
title_sort | pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension |
topic | Reviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9487822/ https://www.ncbi.nlm.nih.gov/pubmed/26028638 http://dx.doi.org/10.1183/16000617.00000815 |
work_keys_str_mv | AT jenkinsdavid pulmonaryendarterectomythepotentiallycurativetreatmentforpatientswithchronicthromboembolicpulmonaryhypertension |