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Perioperative management of pulmonary thrombendarterectomy: institutional experiences from a series of 180 consecutive cases: A-59

Eberle, B.; Kramm, T.; Weiler, N.; Mayer, E.

European Journal of Anaesthesiology: July 2001 - Volume 18 - Issue - p 27
Surgery and Haematology
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Depts. of Anaesthesiology and Cardiothoracic/Vascular Surgery, Johannes Gutenberg University, Mainz, Germany

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) [1]. 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.

Table

Table

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.

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Reference:

1 Dahm M, Mayer E, Eberle B, et al. Surgical aspects of pulmonary thrombendarterectomy. Zentralbl Chir 1997; 122: 649-54. German.
© 2001 European Society of Anaesthesiology