Pulmonary endarterectomy: Part II. Operation, anesthetic management, and postoperative care

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) results from recurrent or incomplete resolution of pulmonary embolism. CTEPH is much more common than generally appreciated. Although pulmonary embolism (PE) affects a large number of Americans, chronic pulmonary thromboembolic hypertension remains underdiagnosed. It is imperative that all patients with pulmonary hypertension (PH) be screened for the presence of CTEPH since this form of PH is potentially curable with pulmonary endarterectomy (PEA) surgery. The success of this procedure depends greatly on the collaboration of a multidisciplinary team approach that includes pulmonary medicine, cardiothoracic surgery, and cardiac anesthesiology. This review, based on the experience of more than 3000 pulmonary endarterectomy surgeries, is divided into 2 parts. Part I focuses on the clinical history and pathophysiology, diagnostic workup, and intraoperative echocardiography. Part II focuses on the surgical approach, anesthetic management, postoperative care, and complications.

Keywords: deep hypothermic circulatory arrest; heparin-induced thrombocytopenia (HIT); pulmonary endarterectomy; pulmonary hemorrhage in PEA; pulmonary thromboendarterectomy; reperfusion lung injury; sickle cell disease; transesophageal echocardiography in CTEPH.