Recent advances in chronic thromboembolic pulmonary hypertension

Erica Stein, Harish Ramakrishna, John G.T. Augoustides

Research output: Contribution to journalReview article

5 Scopus citations

Abstract

Surgical excellence in pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH) has begun to spread around the world. The perioperative mortality for this procedure is typically under 10%. The maximal benefit from PTE is derived in those patients who have a high proximal clot burden that is surgically accessible, as outlined by the Jamieson classification. Residual pulmonary hypertension after successful PTE is common and increasingly is managed with maintenance oral pulmonary vasodilator therapy such as endothelin antagonists, phosphodiesterase inhibitors, and/or prostaglandins. The role of pulmonary vasodilator therapy in CTEPH before PTE is limited and should not delay definitive surgical therapy. Although plain deep hypothermic circulatory arrest (DHCA) is the classic technique for CTEPH, alternatives such as DHCA with antegrade cerebral perfusion are feasible as well. Prolonged mechanical ventilation after PTE remains common in part because of reperfusion pulmonary edema. Careful perioperative management can reduce the incidence of this syndrome. Because ventilator-associated pneumonia is also a common complication after PTE, it represents a major opportunity for outcome improvement, particularly because there are multiple modalities for its prevention and prompt diagnosis.

Original languageEnglish (US)
Pages (from-to)744-748
Number of pages5
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume25
Issue number4
DOIs
StatePublished - Aug 1 2011

Keywords

  • Jamieson classification
  • apixaban
  • bosentan
  • chronic thromboembolic pulmonary hypertension
  • clinical outcomes
  • dabigatran
  • deep hypothermic circulatory arrest
  • direct thrombin inhibitors
  • endothelins
  • epoprostenol
  • factor Xa inhibitors
  • guanylate cyclase
  • moderate hypothermia
  • phosphodiesterases
  • procalcitonin
  • prostaglandins
  • pulmonary hypertension
  • pulmonary thromboendarterectomy
  • reperfusion pulmonary edema
  • right ventricular dysfunction
  • riociguat
  • rivaroxaban
  • selective antegrade cerebral perfusion
  • sildenafil
  • treprostinil
  • ventilator-associated pneumonia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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