Pulmonary thromboendarterectomy

Overview

When conventional medical treatments prove ineffective, a complex surgical procedure referred to as pulmonary thromboendarterectomy (PTE) is employed to remove chronic blood clots from the pulmonary arteries. When diagnosed in its early stages, PTE frequently offers a favorable chance for successful treatment. An alternative term for this procedure is pulmonary endarterectomy, often abbreviated as PEA.

Reasons for undergoing the procedure

Patients with chronic thromboembolic pulmonary hypertension (CTEPH) can have blockages treated by surgeons using pulmonary thromboendarterectomy. This condition is an uncommon yet potentially life-threatening complication that can develop in individuals who have experienced pulmonary embolisms (PEs), which are blood clots in their lungs.

In CTEPH, blood flow is blocked by one or more blood clots that become lodged in the pulmonary arteries (the arteries in the lungs). Medication that thins the blood usually works to clear these obstructions. If blood clots persist despite medical intervention, they can lead to the formation of scar tissue, which in turn elevates blood pressure within the lungs and causes difficulty in breathing. This condition can also cause a narrowing and stiffening of the small blood vessels in the lungs.

Pulmonary thromboendarterectomy (PTE) stands as the sole treatment with the potential to address CTEPH. If left untreated, CTEPH can result in lung damage, heart failure, and even fatal consequences.

You might be qualified for a pulmonary thromboendarterectomy if you have CTEPH based on:

• The intensity of the illness and its manifestations.
• The site, severity, and extent of arterial blockage.
• Your age, physical condition, and heart and lung function.

Healthcare providers prefer pulmonary thromboendarterectomy (PTE) as the treatment of choice when it is possible to safely remove the clots. However, over 40% of individuals (4 out of 10) are not suitable PTE candidates.

A large number of patients are not qualified for PTE due to the surgical intricacy. Your surgical team will employ a cardiopulmonary bypass machine during the treatment, which will pump oxygen into your body in place of your heart and lungs.

PTE also entails cooling your body for extended periods of time in order to halt brain activity, which permits deep hypothermic circulatory arrests, which stop all blood flow. Through the removal of blood from the surgical site, your surgeon will be able to view into your lungs’ arteries and remove any scar tissue. Your brain is shielded from neurological injury during the treatment by the cooling.

Risks

Over the past year, the risk of PTE has significantly declined, and for the majority of patients, the chance of not surviving the procedure is currently as low as 1%. Stroke risk ranges from 1% to 2%.

Some persons may continue to experience recurrent episodes of Pulmonary Hypertension (PH) following PTE, necessitating the use of medication.

Pericardial effusion, or fluid accumulation around the heart, can occur occasionally following heart surgery. You might encounter:

• Sudden dyspnea or trouble breathing.
• Fainting
• Pain in the chest

If you have any of these symptoms, call your emergency contact number or go to the nearest emergency room. Talk to your doctor about any additional symptoms you might be having after PTE.

Before the procedure

You will receive instructions from your healthcare practitioner for how to get ready for the surgery, including if you need to fast or stop taking any medications.

Observe the advice of your doctor for:

• Medications: Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and blood thinners (aspirin, warfarin, or other medications that prevent blood clots and strokes) are frequently stopped by patients. These medications may make bleeding more likely.
• Food and drink: A fast (not eating or drinking) may be prescribed by your doctor before to your procedure. An empty stomach makes anesthesia safer.
• Smoking and alcohol: Reduce alcohol intake and give up smoking. Both can raise the chance of complications and impede the healing process following surgery.

During the procedure

The surgery usually begins early in the morning and lasts for almost six hours. The procedure involves anesthesia.

As PTE progresses, your surgical team:

• To help you breathe, an endotracheal tube (ETT) is inserted via your mouth or nose and connected to a ventilator or oxygen machine.
• Cuts through your sternum, or breastbone, to get to your lungs and heart.
• Attaches you to a cardiopulmonary bypass machine, which performs the functions of your heart and lungs.
• Your body will cool down to 65 degrees Fahrenheit (18 degrees Celsius) gradually.
• Makes use of specialized equipment to remove scar tissue and clots from your arteries.
• Returns your body temperature to normal, disconnects you from the bypass machine, and keeps you attached to the ventilator.
• Closes your chest, leaving tubes in place to remove extra fluid.

After the procedure

After undergoing a Pulmonary Thromboendarterectomy (PTE), you’ll spend the night in the Intensive Care Unit (ICU). The following morning, your medical team will assess your ability to breathe independently and, if you can, they will remove the ventilator.

Typically, the average hospital stay after PTE ranges from seven to ten days. As early as the day after the surgery, you’ll transition from the ICU to an intermediate level of care to initiate your rehabilitation process. This recovery is akin to that following open-heart surgery. Over the course of a few days, you may begin walking and gradually increasing your activity levels. Additionally, various tests will be conducted, including one to determine your oxygen requirements once you return home.

Outcome

Over time, you will gradually regain your ability to resume your regular activities. However, immediately following the surgery, there are specific restrictions in place. For the first six weeks, you are prohibited from driving, working, or lifting anything heavier than ten pounds. Between weeks seven and twelve, you can gradually increase your lifting limit to 25 pounds. After this 12-week period, there are typically no more restrictions.

Usually, around three months after the surgery, you can begin to return to your normal activities. Following the procedure, your breathing capacity and overall activity level tend to improve, and this improvement can continue for up to four years.