Verbelen Tom, Fadel Elie, Wiedenroth Christoph B, Jenkins David P, Madani Michael M
Department of Cardiac Surgery, University Hospitals Leuven and Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.
Thoracic Surgery, Marie Lannelongue Hospital, Paris-Saclay University, Le Plessis Robinson, France.
JHLT Open. 2025 Jul 30;10:100357. doi: 10.1016/j.jhlto.2025.100357. eCollection 2025 Nov.
Chronic thromboembolic pulmonary hypertension requires referral to an expert center for final diagnosis and assessment of treatment possibilities by a multidisciplinary team. Pulmonary endarterectomy is the only potentially curative therapy and therefore remains the treatment of choice. However, many practices and minor technical aspects of this procedure may still provoke controversy. Based on the most recent literature and the author's own experiences and opinions, and in lack of clear guidelines, this review discusses the rationale for blood management strategies; practices during deep hypothermic circulatory arrest; concomitant surgical procedures; pulmonary endarterectomy in specific patient populations, in redo setting and for other diseases; the role of balloon pulmonary angioplasty and of minimal access techniques; and the required surgical expertise. Well-founded recommendations can only be made for a few of them.
慢性血栓栓塞性肺动脉高压需要转诊至专家中心，由多学科团队进行最终诊断并评估治疗可能性。肺动脉内膜剥脱术是唯一具有潜在治愈性的治疗方法，因此仍是首选治疗方式。然而，该手术的许多操作和一些技术细节仍可能引发争议。基于最新文献以及作者自身的经验和观点，且由于缺乏明确的指南，本综述讨论了血液管理策略的基本原理；深低温停循环期间的操作；同期手术；特定患者群体、再次手术及其他疾病情况下的肺动脉内膜剥脱术；球囊肺动脉成形术和微创技术的作用；以及所需的手术专业知识。目前只能针对其中少数方面给出有充分依据的建议。
