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PTE surgery

The treatment of choice for CTEPH

Pulmonary thromboendarterectomy (PTE) surgery (also called pulmonary endarterectomy [PEA]) is the only treatment for CTEPH that can be curative, so it is the recommended first option for CTEPH patients.1 According to an International Prospective Registry, approximately 63% of CTEPH patients are operable.2

63% of CTEPH patients are eligible for PTE2

PTE should be offered to all eligible patients with CTEPH. Most patients experience significant improvements in symptoms and hemodynamics.2-4 The international registry of incident cases of CTEPH reported a 3-year survival of 90% in those receiving PTE versus 70% in those who did not have surgery.3

Patients who have operable CTEPH should be referred for surgery without delay5

  • PTE surgery is a complex bilateral procedure, which requires median sternotomy, cardiopulmonary bypass, deep hypothermia, and periods of circulatory arrest6

  • PTE allows for the removal of obstructing lesions, resulting in an improvement and often normalization of pulmonary hemodynamics7,8

  • Rates of residual pulmonary hypertension (PH) following PTE have been reported at 10% to 35%9-11

pulmonary thromboendarterectomy image

Images courtesy of Cameron D Wright, MD.

pulmonary thromboendarterectomy image

Images courtesy of Cameron D Wright, MD.

Watch a real PTE surgery

Cameron Wright, MD, of Massachusetts General Hospital performs pulmonary thromboendarterectomy (PTE) on a patient with CTEPH.

Post-operative follow-up

  • Early reocclusion prophylaxis using intravenous or subcutaneous heparin and subsequent lifelong anticoagulation is mandatory for all patients following PTE surgery1

  • Maximum benefits of PTE may not be observed for ≥6 months, making early and frequent post-operative follow-up essential1

  • Hemodynamic benefits may be seen immediately after surgery, but maximum benefits may not be observed for 6 months or longer1

  • Hemodynamic reevaluation should be conducted 6–12 months after surgery to exclude recurrent or residual symptomatic CTEPH1

  • Treatment with vasodilators may be beneficial for recurrent or residual CTEPH1

 

Following PTE, patients must be closely monitored and reassessed regularly.1 Up to one-third of patients may have residual CTEPH following PTE.9 Therefore, physicians should remain vigilant in assessing for signs of persistent/recurrent CTEPH for at least 1 year following surgery.1 Continuity of care between the pulmonary specialist and primary care physician is essential during this crucial time period.

Continue to Assess

Post-PTE Surgery Discussion Guide for Patients

Give this useful guide to your PTE patients to help them assess and report their progress after PTE surgery.

 

References:

1. Keogh AM, Mayer E, Benza RL, et al. Interventional and surgical modalities of treatment in pulmonary hypertension. J Am Coll Cardiol. 2009;54(suppl 1):S67-S77. 2. Pepke-Zaba J, Delcroix M, Lang I, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation. 2011;124(18):1973-1981. 3. Kim NH, Delcroix M, Jais X, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2019;53:1801915. 4. Galiè N, Humbert M, Vachiery JL, et al; ESC Scientific Document Group. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2016;37(1):67-119. 5. Kim NH, Delcroix M, Jenkins DP, et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013;62(suppl D):D92-D99. 6. Jamieson SW, Kapelanski DP, Sakakibara N, et al. Pulmonary endarterectomy: experience and lessons learned in 1,500 cases. Ann Thorac Surg. 2003;76(5):1457-1464. 7. Piazza G and Goldhaber SZ. Chronic thromboembolic pulmonary hypertension. N Engl J Med. 2011;364:351-360. 8. Rahnavardi M, Yan TD, Cao C, et al. Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review. Ann Thorac Cardiovasc Surg. 2011;17(5):435-445. 9. Freed DH, Thomson BM, Berman M, et al. Survival after pulmonary thromboendarterectomy: effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg. 2011;141(2):383-387. 10. Wittine LM and Auger WR. Curr Treat Options Cardiovasc Med. 2010;12:131-141. 11. Mayer E, Jenkins D, D’Armini A, et al. Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. J Thorac Cardiovasc Surg. 2011;141(3):702-710.