Pulmonary thromboendarterectomy—the Royal Papworth experience

Abstract

and review activity and outcomes by era at a high-volume PTE center. During this period the understanding of chronic thromboembolic pulmonary hypertension (CTEPH) increased and drug treatments and balloon angioplasty were developed. We also review our contribution to the better understanding of this surgery and CTEPH. Methods: We retrospectively reviewed all patients undergoing PTE for CTEPH at our center between Jan 1997 and Sept 2019, dividing them into four equal cohorts. Pre-operative characteristics and postoperative outcomes are described by era. A MEDLINE search was performed and original scientific clinical publications from this unit were reviewed. Their contemporary relevance and influence to the evolution of the clinical service are discussed.Results: Over this 23-year period from the commencement of our program, 2116 consecutive PTE were performed. The mean patient age was 57.8 years (range 14−89). The first 25% of our PTE were performed over 12 years whilst the most recent 25% were performed in less than three years. Over time, the average pre-operative mean pulmonary artery pressure has not changed significantly. The 30-day mortality by era quartile has progressively fallen from 12.3% to 1.9% most recently (P<0.001). Overall, one year survival exceeded 90%. 17 publications influenced our practice development during this period.Conclusions: There was a consistent increase in activity and significant improvement in outcomes between the first and last quartiles of activity studied.

Can regional cerebral oxygen saturation monitoring during circulatory arrest time predict postoperative neurological dysfunction in patients undergoing surgical pulmonary thromboendarterectomy? Useful index for short‐ and long‐term outcomes

“…27 Currently, PTE is indicated in patients with segmental and subsegmental pulmonary artery disease with acceptable mid-and long-term results. 6,8,[12][13][14][17][18][19]21,[23][24][25] On the other hand, the balloon pulmonary angioplasty treatment for chronic PA occlusion is a novel technique for the primary treatment of CTHE and secondary treatment for residual PA thrombosis after PTE. 8,11,21,27 Brain hypoperfusion during hypothermia and CA affect brain metabolism and induce apoptosis and death of nerve cells.…”

“…6,8,[12][13][14][17][18][19]21,[23][24][25] On the other hand, the balloon pulmonary angioplasty treatment for chronic PA occlusion is a novel technique for the primary treatment of CTHE and secondary treatment for residual PA thrombosis after PTE. 8,11,21,27 Brain hypoperfusion during hypothermia and CA affect brain metabolism and induce apoptosis and death of nerve cells. In patients who undergo thoracic aorta surgery under HCA, brain perfusion is maintained via antegrade cerebral perfusion during CA, while in patients undergoing PTE all perfusion is stopped during CA.…”

“…Although the annual incidence of CTHE varies from 1.9 to 3–5 cases per 100,000 population, many cases with CTEPH remain undiagnosed 27 . Currently, PTE is indicated in patients with segmental and subsegmental pulmonary artery disease with acceptable mid‐ and long‐term results 6,8,12–14,17–19,21,23–25 . On the other hand, the balloon pulmonary angioplasty treatment for chronic PA occlusion is a novel technique for the primary treatment of CTHE and secondary treatment for residual PA thrombosis after PTE 8,11,21,27 …”

“…Hypothermic circulatory arrest with total arrest is an established technique for PTE in patients with CTEPH. In the last 3 years, many studies from national databases have reported outcomes after surgical PTE in literature 6–26 . A recent publication from the International Society of Heart Lung Transplantation presents the current aspects of the management and treatment of patients with CTEPH and surgical PTE 21 .…”

Pulmonary thromboendarterectomy in chronic pulmonary disease—the Royal Papworth Hospital experience

“…Our own experience and some of the lessons we have learnt at Royal Papworth hospital are documented in the accompanying report (1). In retrospect, patients in the United Kingdom (UK) have been fortunate due to the foresight of the founding doctors and commissioners of our service.…”