Introduction: Chronic thrombembolic pulmonary hypertension (CTEPH) can be treated surgically by pulmonary thromben-darterectomy (PTE). PTE is performed on cardiopulmonary bypass (CPB) with intermittent deep hypothermic circulatory arrest (DHCA) . Perioperative risk is dominated by persistent pulmonary hypertension and acute ischaemia-reperfusion injury of the lungs, resulting in early postoperative RV failure and/or ARDS. We report the 11-year progress in perioperative management and outcome of these patients at our institution.
Method: Database analysis and retrospective chart review of 183 patients undergoing PTE between 1989 and 2000. Prospectively defined treatment protocols were followed throughout observation periods 1989-94 (P1) and 1995-2000 (P2). In 1995, several aspects of perioperative care (e.g. omission of disobliteration prior to deep hypothermia, of fluid restriction and of cardiac output enhancement with catecholamines/vasodilators, change from volume-constant to pressure-constant ventilation and from prolonged ventilation to rapid weaning), with the goal of reducing blood trauma, pulmonary hyperperfusion and ventilator-induced lung injury. Data of periods 1 and 2 (means ± SD) were compared by nonparametric testing or contingency table analysis.
Results: The results are shown in the table.
Discussion: In this high-risk, but curative procedure, the adoption of less invasive perioperative regimens by both surgery and anaesthesiology (e.g. shortened DHCA, pressure-constant ventilation, avoidance of large catecholamine and vasodilator dosage, early weaning) reduced ventilator days, ICU stay, and perioperative mortality without compromising functional results.
1 Dahm M, Mayer E, Eberle B, et al.
Surgical aspects of pulmonary thrombendarterectomy. Zentralbl Chir
: 649-54. German.