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Pulmonary endarterectomy

Published online by Cambridge University Press:  29 August 2006

K. Valchanov
Affiliation:
Papworth Hospital NHS Trust, Cambridge, UK
A. Vuylsteke
Affiliation:
Papworth Hospital NHS Trust, Cambridge, UK
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Abstract

Summary

Chronic thromboembolic pulmonary hypertension is a condition that is recognised in an increased percentage of patients. Pulmonary endarterectomy is recognised as being the only curative option for a subgroup of those patients, but anaesthesiologists and intensivists face many challenges in how they manage these patients perioperatively. Ultimately, it is the combination of skills in a multidisciplinary team that leads to a successful procedure and dramatically improves patient's quality of life and life expectancy.

Type
EACTA Review
Copyright
2006 European Society of Anaesthesiology

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References

Wessler S, Freiman DG, Ballon JD, Katz JH, Wolff R, Wolf E. Experimental pulmonary embolism with serum-induced thrombi. Am J Pathol 1961; 38: 89101.Google Scholar
Dalen JE, Banas JrJS, Brooks HL, Evans GL, Paraskos JA, Dexter L. Resolution rate of acute pulmonary embolism in man. N Engl J Med 1969; 280: 11941199.Google Scholar
Azarian R, Wartski M, Collignon MAet al. Lung perfusion scans and hemodynamics in acute and chronic pulmonary embolism. J Nucl Med 1997; 38: 980983.Google Scholar
Kimura H, Okada O, Tanabe Net al. Plasma monocyte chemoattractant protein-1 and pulmonary vascular resistance in chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med 2001; 164: 319324.Google Scholar
Tanaka Y, Schuster DP, Davis EC, Patterson GA, Botney MD. The role of vascular injury and hemodynamics in rat pulmonary artery remodeling. J Clin Invest 1996; 98: 434442.Google Scholar
Fedullo PF, Auger WR, Channick RN, Kerr KM, Rubin LJ. Chronic thromboembolic pulmonary hypertension. Clin Chest Med 2001; 22: 561581.Google Scholar
Moser KM, Braunwald NS. Successful surgical intervention in severe chronic thromboembolic pulmonary hypertension. Chest 1973; 64: 2935.Google Scholar
Daily PO, Dembitsky WP, Peterson KL, Moser KM. Modifications of techniques and early results of pulmonary thromboendarterectomy for chronic pulmonary embolism. J Thorac Cardiovasc Surg 1987; 93: 221233.Google Scholar
Brown DL, Bodary AK, Kirby RR. Anesthetic management of pulmonary thromboendarterectomy. Anesthesiology 1984; 61: 197200.Google Scholar
Jamieson SW, Auger WR, Fedullo PFet al. Experience and results with 150 pulmonary thromboendarterectomy operations over a 29-month period. J Thorac Cardiovasc Surg 1993; 106: 116126.Google Scholar
Mellemkjaer S, Ilkjaer LB, Klaaborg KEet al. Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ten years experience in Denmark. Scand Cardiovasc J 2006; 40: 4953.Google Scholar
D'Armini AM, Zanotti G, Vigano M. Pulmonary endarterectomy: the treatment of choice for chronic thromboembolic pulmonary hypertension. Ital Heart J 2005; 6: 861868.Google Scholar
Klepetko W, Mayer E, Sandoval Jet al. Interventional and surgical modalities of treatment for pulmonary arterial hypertension. J Am Coll Cardiol 2004; 43: 73S80S.Google Scholar
Jamieson SW, Kapelanski DP, Sakakibara Net al. Pulmonary endarterectomy: experience and lessons learned in 1,500 cases. Ann Thorac Surg 2003; 76: 14571462.Google Scholar
Proceedings of the 3rd World Symposium on Pulmonary Arterial Hypertension, Venice, Italy, June 23–25, 2003. J Am Coll Cardiol 2004; 43: 1S90S.
Jamieson SW, Kapelanski DP. Pulmonary endarterectomy. Curr Probl Surg 2000; 37: 165252.Google Scholar
Fedullo PF, Auger WR, Kerr KM, Rubin LJ. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2001; 345: 14651472.Google Scholar
Paw P, Jamieson SW. Pulmonary thromboendarterectomy for the treatment of pulmonary embolism caused by renal cell carcinoma. J Thorac Cardiovasc Surg 1997; 114: 295297.Google Scholar
Heck JrHA, Gross CM, Houghton JL. Long-term severe pulmonary hypertension associated with right atrial myxoma. Chest 1992; 102: 301303.Google Scholar
Mayer E, Kriegsmann J, Gaumann Aet al. Surgical treatment of pulmonary artery sarcoma. J Thorac Cardiovasc Surg 2001; 121: 7782.Google Scholar
Moser KM, Auger WR, Fedullo PF, Jamieson SW. Chronic thromboembolic pulmonary hypertension: clinical picture and surgical treatment. Eur Respir J 1992; 5: 334342.Google Scholar
Menzel T, Wagner S, Kramm Tet al. Pathophysiology of impaired right and left ventricular function in chronic embolic pulmonary hypertension: changes after pulmonary thromboendarterectomy. Chest 2000; 118: 897903.Google Scholar
Moser KM, Auger WR, Fedullo PF. Chronic major-vessel thromboembolic pulmonary hypertension. Circulation 1990; 81: 17351743.Google Scholar
Pengo V, Lensing AW, Prins MHet al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350: 22572264.Google Scholar
Wolf M, Boyer-Neumann C, Parent Fet al. Thrombotic risk factors in pulmonary hypertension. Eur Respir J 2000; 15: 395399.Google Scholar
Auger WR, Permpikul P, Moser KM. Lupus anticoagulant, heparin use, and thrombocytopenia in patients with chronic thromboembolic pulmonary hypertension: a preliminary report. Am J Med 1995; 99: 392396.Google Scholar
Colorio CC, Martinuzzo ME, Forastiero RR, Pombo G, Adamczuk Y, Carreras LO. Thrombophilic factors in chronic thromboembolic pulmonary hypertension. Blood Coagul Fibrin 2001; 12: 427432.Google Scholar
Martinuzzo ME, Pombo G, Forastiero RR, Cerrato GS, Colorio CC, Carreras LO. Lupus anticoagulant, high levels of anticardiolipin, and anti-beta2-glycoprotein I antibodies are associated with chronic thromboembolic pulmonary hypertension. J Rheumatol 1998; 25: 13131319.Google Scholar
Bonderman D, Turecek PL, Jakowitsch Jet al. High prevalence of elevated clotting factor VIII in chronic thromboembolic pulmonary hypertension. Thromb Haemost 2003; 90: 372376.Google Scholar
Olman MA, Marsh JJ, Lang IM, Moser KM, Binder BR, Schleef RR. Endogenous fibrinolytic system in chronic large-vessel thromboembolic pulmonary hypertension. Circulation 1992; 86: 12411248.Google Scholar
Fedullo PF, Rubin LJ, Kerr KM, Auger WR, Channick RN. The natural history of acute and chronic thromboembolic disease: the search for the missing link. Eur Respir J 2000; 15: 435437.Google Scholar
Lewczuk J, Piszko P, Jagas Jet al. Prognostic factors in medically treated patients with chronic pulmonary embolism. Chest 2001; 119: 818823.Google Scholar
Egermayer P, Peacock AJ. Is pulmonary embolism a common cause of chronic pulmonary hypertension? Limitations of the embolic hypothesis. Eur Respir J 2000; 15: 440448.Google Scholar
Langer F, Schramm R, Bauer M, Tscholl D, Kunihara T, Schafers HJ. Cytokine response to pulmonary thromboendarterectomy. Chest 2004; 126: 135141.Google Scholar
Thistlethwaite PA, Lee SH, Du LLet al. Human angiopoietin gene expression is a marker for severity of pulmonary hypertension in patients undergoing pulmonary thromboendarterectomy. J Thorac Cardiovasc Surg 2001; 122: 6573.Google Scholar
Fedullo PF, Kerr KM, Auger WR, Jamieson SW, Kapelanski DP. Chronic thromboembolic pulmonary hypertension. Semin Respir Crit Care Med 2000; 21: 563574.Google Scholar
Auger W, Moser K. Pulmonary flow murmurs: a distinctive physical sign found in chronic pulmonary thromboembolic pulmonary hypertension. Clin Res 1989; 37: 147A.Google Scholar
Ryan KL, Fedullo PF, Davis GB, Vasquez TE, Moser KM. Perfusion scan findings understate the severity of angiographic and hemodynamic compromise in chronic thromboembolic pulmonary hypertension. Chest 1988; 93: 11801185.Google Scholar
Auger WR, Fedullo PF, Moser KM, Buchbinder M, Peterson KL. Chronic major-vessel thromboembolic pulmonary artery obstruction: appearance at angiography. Radiology 1992; 182: 393398.Google Scholar
Bergin CJ, Rios G, King MA, Belezzuoli E, Luna J, Auger WR. Accuracy of high-resolution CT in identifying chronic pulmonary thromboembolic disease. Am J Roentgenol 1996; 166: 13711377.Google Scholar
Nicod P, Peterson K, Levine Met al. Pulmonary angiography in severe chronic pulmonary hypertension. Ann Intern Med 1987; 107: 565568.Google Scholar
Oikonomou A, Dennie CJ, Muller NL, Seely JM, Matzinger FR, Rubens FD. Chronic thromboembolic pulmonary arterial hypertension: correlation of postoperative results of thromboendarterectomy with preoperative helical contrast-enhanced computed tomography. J Thorac Imag 2004; 19: 6773.Google Scholar
Sompradeekul S, Fedullo P, Kerr IH, Channick RH, Auger W. The role of pulmonary angioscopy in the preoperative assessment of patients with thromboembolic pulmonary hypertension. Am J Respir Crit Care Med 1999; 159: A456.Google Scholar
Dartevelle P, Fadel E, Chapelier Aet al. Angioscopic video-assisted pulmonary endarterectomy for post-embolic pulmonary hypertension. Eur J Cardiothorac Surg 1999; 16: 3843.Google Scholar
Thistlethwaite PA, Auger WR, Madani MM, Pradhan S, Kapelanski DP, Jamieson SW. Pulmonary thromboendarterectomy combined with other cardiac operations: indications, surgical approach, and outcome. Ann Thorac Surg 2001; 72: 1317.Google Scholar
Kapitan KS, Buchbinder M, Wagner PD, Moser KM. Mechanisms of hypoxemia in chronic thromboembolic pulmonary hypertension. Am Rev Respir Dis 1989; 139: 11491154.Google Scholar
Feinstein JA, Goldhaber SZ, Lock JE, Ferndandes SM, Landzberg MJ. Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension. Circulation 2001; 103: 1013.Google Scholar
Ghofrani HA, Schermuly RT, Rose Fet al. Sildenafil for long-term treatment of nonoperable chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med 2003; 167: 11391141.Google Scholar
Sheth A, Park JE, Ong YE, Ho TB, Madden BP. Early haemodynamic benefit of sildenafil in patients with coexisting chronic thromboembolic pulmonary hypertension and left ventricular dysfunction. Vascul Pharmacol 2005; 42: 4145.Google Scholar
Bonderman D, Nowotny R, Skoro-Sajer Net al. Bosentan therapy for inoperable chronic thrombo-embolic pulmonary hypertension. Chest 2005; 128: 25992603.Google Scholar
Hoeper MM, Kramm T, Wilkens Het al. Bosentan therapy for inoperable chronic thromboembolic pulmonary hypertension. Chest 2005; 128: 23632367.Google Scholar
Nagaya N, Shimizu Y, Satoh Tet al. Oral beraprost sodium improves exercise capacity and ventilatory efficiency in patients with primary or thromboembolic pulmonary hypertension. Heart 2002; 87: 340345.Google Scholar
Nagaya N, Sasaki N, Ando Met al. Prostacyclin therapy before pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. Chest 2003; 123: 338343.Google Scholar
Oudiz RJ, Schilz RJ, Barst Ret al. Treprostinil, a prostacyclin analogue, in pulmonary arterial hypertension associated with connective tissue disease. Chest 2004; 126: 420427.Google Scholar
Olschewski H, Simonneau G, Galie Net al. Inhaled iloprost for severe pulmonary hypertension. N Engl J Med 2002; 347: 322329.Google Scholar
Kerr KM, Rubin LJ. Epoprostenol therapy as a bridge to pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. Chest 2003; 123: 319320.Google Scholar
Rubin LJ, Badesh DB, Barst Ret al. Bosentan therapy for pulmonary hypertension. N Engl J Med 2002; 346: 896902.Google Scholar
D'Armini AM, Cattadori B, Monterosso Cet al. Pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension: hemodynamic characteristics and changes. Eur J Cardiothorac Surg 2000; 18: 696701.Google Scholar
Hartz RS, Byrne JG, Levitsky S, Park J, Rich S. Predictors of mortality in pulmonary thromboendarterectomy. Ann Thorac Surg 1996; 62: 12551259.Google Scholar
Thistlethwaite PA, Mo M, Madani MMet al. Operative classification of thromboembolic disease determines outcome after pulmonary endarterectomy. J Thorac Cardiovasc Surg 2002; 124: 12031211.Google Scholar
Tscholl D, Langer F, Wendler O, Wilkens H, Georg T, Schafers HJ. Pulmonary thromboendarterectomy – risk factors for early survival and hemodynamic improvement. Eur J Cardiothorac Surg 2001; 19: 771776.Google Scholar
Hagl C, Khaladj N, Peters Tet al. Technical advances of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. Eur J Cardiothorac Surg 2003; 23: 776781.Google Scholar
Hans P, Bonhomme V. The rationale for perioperative brain protection. Eur J Anaesthesiol 2004; 21: 15.Google Scholar
Dartevelle P, Fadel E, Chapelier Aet al. [Pulmonary thromboendarterectomy with video-angioscopy and circulatory arrest: an alternative to cardiopulmonary transplantation and post-embolism pulmonary artery hypertension.] Chirurgie 1998; 123: 3240.Google Scholar
Rubens FD, Sabloff M, Wells PS, Bourke M. Use of recombinant-hirudin in pulmonary thromboendarterectomy. Ann Thorac Surg 2000; 69: 19421943.Google Scholar
Manecke JrGR, Parimucha M, Stratmann Get al. Deep hypothermic circulatory arrest and the femoral-to-radial arterial pressure gradient. J Cardiothorac Vasc Anesth 2004; 18: 175179.Google Scholar
Edmonds HL, Ganzel BL, Austin EH. Cerebral oximetry for cardiac and vascular surgery. Semin Cardiothorac Vasc Anesth 2004; 8: 147166.Google Scholar
Vuylsteke A, Feneck RO, Jolin-Mellgard Aet al. Perioperative blood pressure control: a prospective survey of patient management in cardiac surgery. J Cardiothorac Vasc Anesth 2000; 14: 269273.Google Scholar
Gardeback M, Larsen FF, Radegran K. Nitric oxide improves hypoxaemia following reperfusion oedema after pulmonary thromboendarterectomy. Br J Anaesth 1995; 75: 798800.Google Scholar
Pinelli G, Mertes PM, Carteaux JPet al. Inhaled nitric oxide as an adjunct to pulmonary thromboendarterectomy. Ann Thorac Surg 1996; 61: 227229.Google Scholar
Imanaka H, Miyano H, Takeuchi M, Kumon K, Ando M. Effects of nitric oxide inhalation after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism. Chest 2000; 118: 3946.Google Scholar
Moser KM, Bloor CM. Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest 1993; 103: 685692.Google Scholar
Baskett RJ, Ghali WA, Maitland A, Hirsch GM. The intraaortic balloon pump in cardiac surgery. Ann Thorac Surg 2002; 74: 12761287.Google Scholar
Darrah WC, Sharpe MD, Guiraudon GM, Neal A. Intraaortic balloon counterpulsation improves right ventricular failure resulting from pressure overload. Ann Thorac Surg 1997; 64: 17181723.Google Scholar
Arafa OE, Geiran OR, Andersen K, Fosse E, Simonsen S, Svennevig JL. Intraaortic balloon pumping for predominantly right ventricular failure after heart transplantation. Ann Thorac Surg 2000; 70: 15871593.Google Scholar
Nordhaug D, Steensrud T, Muller S, Husnes KV, Myrmel T. Intraaortic balloon pumping improves hemodynamics and right ventricular efficiency in acute ischemic right ventricular failure. Ann Thorac Surg 2004; 78: 14261432.Google Scholar
Dartevelle P, Fadel E, Mussot Set al. Chronic thromboembolic pulmonary hypertension. Eur Respir J 2004; 23: 637648.Google Scholar
Kramm T, Eberle B, Guth S, Mayer E. Inhaled iloprost to control residual pulmonary hypertension following pulmonary endarterectomy. Eur J Cardiothorac Surg 2005; 28: 882888.Google Scholar
Kramm T, Eberle B, Krummenauer F, Guth S, Oelert H, Mayer E. Inhaled iloprost in patients with chronic thromboembolic pulmonary hypertension: effects before and after pulmonary thromboendarterectomy. Ann Thorac Surg 2003; 76: 711718.Google Scholar
Levinson RM, Shure D, Moser KM. Reperfusion pulmonary edema after pulmonary artery thromboendarterectomy. Am Rev Respir Dis 1986; 134: 12411245.Google Scholar
Lee KC, Cho YL, Lee SY. Reperfusion pulmonary edema after pulmonary endarterectomy. Acta Anaesthesiol Sin 2001; 39: 97101.Google Scholar
Loubser PG. Case 3 – 1998. Pulmonary reperfusion edema associated with pulmonary thromboendarterectomy. J Cardiothorac Vasc Anesth 1998; 12: 353357.Google Scholar
Fadel E, Mazmanian GM, Chapelier Aet al. Lung reperfusion injury after chronic or acute unilateral pulmonary artery occlusion. Am J Respir Crit Care Med 2004; 157: 12941300.Google Scholar
Kerr KM, Auger WR, Marsh JJet al. The use of cylexin (CY-1503) in prevention of reperfusion lung injury in patients undergoing pulmonary thromboendarterectomy. Am J Respir Crit Care Med 2000; 162: 1420.Google Scholar
Mares P, Gilbert TB, Tschernko EMet al. Pulmonary artery thromboendarterectomy: a comparison of two different postoperative treatment strategies. Anesth Analg 2000; 90: 267273.Google Scholar
Wragg RE, Dimsdale JE, Moser KM, Daily PO, Dembitsky WP, Archibald C. Operative predictors of delirium after pulmonary thromboendarterectomy. A model for postcardiotomy delirium? J Thorac Cardiovasc Surg 1988; 96: 524529.Google Scholar
Sakamaki F, Kyotani S, Nagaya N, Sato N, Oya H, Nakanishi N. Increase in thrombomodulin concentrations after pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension. Chest 2003; 124: 13051311.Google Scholar
Nagaya N, Ando M, Oya Het al. Plasma brain natriuretic peptide as a noninvasive marker for efficacy of pulmonary thromboendarterectomy. Ann Thorac Surg 2002; 74: 180184.Google Scholar
Manecke JrGR, Kotzur A, Atkins Get al. Massive pulmonary hemorrhage after pulmonary thromboendarterectomy. Anesth Analg 2004; 99: 672675.Google Scholar
Cerveri I, D'Armini AM, Vigano M. Pulmonary thromboendarterectomy almost 50 years after the first surgical attempts. Heart 2003; 89: 369370.Google Scholar
Manecke JrGR, Wilson WC, Auger WR, Jamieson SW. Chronic thromboembolic pulmonary hypertension and pulmonary thromboendarterectomy. Semin Cardiothorac Vasc Anesth 2005; 9: 189204.Google Scholar
Archibald CJ, Auger WR, Fedullo PFet al. Long-term outcome after pulmonary thromboendarterectomy. Am J Respir Crit Care Med 1999; 160: 523528.Google Scholar
Archibald CJ, Auger WR, Fedullo PF. Outcome after pulmonary thromboendarterectomy. Semin Thorac Cardiovasc Surg 1999; 11: 164171.Google Scholar
Menzel T, Kramm T, Wagner S, Mohr-Kahaly S, Mayer E, Meyer J. Improvement of tricuspid regurgitation after pulmonary thromboendarterectomy. Ann Thorac Surg 2002; 73: 756761.Google Scholar
Kapitan KS, Clausen JL, Moser KM. Gas exchange in chronic thromboembolism after pulmonary thromboendarterectomy. Chest 1990; 98: 1419.Google Scholar
Tanabe N, Okada O, Nakagawa Yet al. The efficacy of pulmonary thromboendarterectomy on long-term gas exchange. Eur Respir J 1997; 10: 20662072.Google Scholar
Zoia MC, D'Armini AM, Beccaria Met al. Mid term effects of pulmonary thromboendarterectomy on clinical and cardiopulmonary function status. Thorax 2002; 57: 608612.Google Scholar
Bernstein RJ, Ford RL, Clausen JL, Moser KM. Membrane diffusion and capillary blood volume in chronic thromboembolic pulmonary hypertension. Chest 1996; 110: 14301436.Google Scholar
Barzaghi N, Maurelli M, Emmi Vet al. Pulmonary thromboendarterectomy in a patient with cryoagglutinins. J Cardiothorac Vasc Anesth 2000; 14: 447448.Google Scholar
Murali B, Drain A, Seller D, Dunning J, Vuylsteke A. Pulmonary thromboendarterectomy in a case of hereditary stomatocytosis. Br J Anaesth 2003; 91: 739741.Google Scholar
Yung GL, Channick RN, Fedullo PFet al. Successful pulmonary thromboendarterectomy in two patients with sickle cell disease. Am J Respir Crit Care Med 1998; 157: 16901693.Google Scholar
Vocelka CR, Lindley GG, Mulligan MS. Cardiopulmonary bypass with deep hypothermic circulatory arrest for a patient with sickle cell anemia: a case report. J Extra Corpor Technol 2001; 33: 243244.Google Scholar