Thromboendarterectomy for severe chronic thromboembolic pulmonary hypertension.

Pulmonary thromboendarterectomy is a curative surgical procedure for chronic thromboembolic pulmonary hypertension. The aim of this study was to clarify whether severe hemodynamic compromise affects surgical outcome. We studied 19 patients who underwent pulmonary thromboendarterectomy and compared 11 with pulmonary vascular resistance < 1,000 dyne x s x cm(-5) (group 1) and 8 with pulmonary vascular resistance > 1,000 dyne x s x cm(-5) (group 2). Mean pulmonary artery pressure and pulmonary vascular resistance decreased significantly after surgery in both groups. The incidence of postoperative complications did not differ between groups; however, one patient in group 2 died of multiorgan failure. The overall mortality rate was 5.3%, and the rate in group 2 was 13%. Our results indicate that preoperative hemodynamic compromise does not affect surgical outcome. Patients with high pulmonary vascular resistance can be treated effectively by thromboendarterectomy, with acceptable morbidity and mortality.