Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension

C HRONIC thromboembolic pulmonary disease is an important cause of severe pulmonary hypertension and is associated with significant morbidity and mortality.At 2-yr follow-up, 3.8% of survivors of an acute pulmonary embolic event develop chronic thromboembolic pulmonary hypertension (CTEPH) defined as a persistent mean pulmonary arterial pressure greater than 25 mmHg for 6 months after the inciting event.1,2 Chronic thromboembolic pulmonary hypertension is progressive in nature and carries a poor prognosis due to the limited efficacy of medical therapy.Surgical intervention by pulmonary thromboendarterectomy (PTE) or lung transplantation is the only effective cure. 1 However, because the mortality rate of untreated CTEPH approaches 90% after 3 yr, the scarcity of available organs limits the viability of transplantation as a therapeutic option.3 Therefore, PTE has become the therapy of choice for patients with CTEPH, and a thorough understanding of the procedure and the medical management of these patients is necessary.We now review the anesthetic management and perioperative outcomes of the patients undergoing PTE.