Technique of pulmonary thromboendarterectomy for chronic pulmonary embolism

Pulmonary embolism infrequently results in severe chronic pulmonary arterial obstruction. However, when it does, affected patients are significantly symptomatic and have shortened survival. Medical management has proven ineffective. In the majority of surgical reports, unilateral thoracotomy with di...

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Bibliographic Details
Published inJournal of cardiac surgery Vol. 4; no. 1; p. 10
Main Authors Daily, P O, Dembitsky, W P, Iversen, S
Format Journal Article
LanguageEnglish
Published United States 01.03.1989
Subjects
Cardiopulmonary Bypass
Chronic Disease
Endarterectomy - methods
Female
Heart Arrest, Induced
Hospital Mortality
Humans
Intraoperative Care
Male
Middle Aged
Pulmonary Artery - surgery
Pulmonary Embolism - mortality
Pulmonary Embolism - surgery
Sternum - surgery
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Summary:Pulmonary embolism infrequently results in severe chronic pulmonary arterial obstruction. However, when it does, affected patients are significantly symptomatic and have shortened survival. Medical management has proven ineffective. In the majority of surgical reports, unilateral thoracotomy with distal pulmonary arteriotomies has been emphasized. The average operative mortality was 22%. In this article, we discuss various preoperative considerations and describe in detail a surgical approach using median sternotomy for bilateral pulmonary thromboendarterectomy with cardiopulmonary bypass, deep hypothermia and circulatory arrest. With this standardized approach in 103 consecutive patients from October 1, 1984, to September 20, 1988, the hospital mortality (death within 30 days or during hospitalization) has been 11.7%.
ISSN:0886-0440
DOI:10.1111/j.1540-8191.1989.tb00253.x