Pulmonary Thromboendarterectomy

Pulmonary thromboendarterectomy is a complex open-heart operation used to treat chronic thromboembolic pulmonary hypertension (CTEPH), a rare but serious condition in which blood clots form in the pulmonary (lung) arteries, restricting or blocking blood flow, thereby leading to high blood pressure in these arteries. CTEPH can cause severe shortness of breath and fatigue. Without treatment, the condition can lead to heart failure and death, making a timely diagnosis and treatment extremely important.

Pulmonary thromboendarterectomy, an operation performed at only a few centers across the United States, involves the surgical removal of those blood clots. In most cases, the procedure results in an immediate, long-lasting stabilization of blood pressure in the pulmonary arteries, as well as improved blood flow from the heart to the lungs. The procedure relieves symptoms and improves quality of life for most people who undergo it. It is the only treatment that can cure CTEPH.

The pulmonary arteries play an essential role in blood circulation. In a healthy individual, they deliver blood from the heart to the lungs, picking up oxygen along the way. The oxygenated blood then returns to the heart, which pumps it to the rest of the body. The increased blood pressure makes it harder for the heart to pump blood to the lungs. As a result, the heart—specifically its right side—must pump harder than usual to keep up with the body’s needs. Over time, this can lead to right-sided heart failure.

Pulmonary thromboendarterectomy (PTE) is a complex surgery to remove long-term blood clots from arteries in your lungs that can’t be treated with medication. These blockages occur due to chronic thromboembolic pulmonary hypertension (CTEPH), a rare complication in people who’ve had blood clots in their lungs.

Who might need PTE?

If you have CTEPH, you may be eligible for pulmonary thromboendarterectomy depending on:

• The severity of the condition and symptoms.
• The location, degree and extent of artery blockage.
• Your age, health and how well your heart and lungs work.

If the clots can be safely removed, healthcare providers consider PTE the treatment of choice. But about 40% of people (4 out of 10) aren’t good candidates for PTE.

Many people aren’t eligible for PTE because of the complexity of the surgery. During the procedure, your surgical team uses cardiopulmonary bypass machine, which takes over the job of your heart and lungs and provides your body with oxygen.