Publications

Pulmonary thromboendarterectomy is the gold standard surgery for chronic thromboembolic pulmonary hypertension, but it is commonly performed under deep hypothermic circulatory arrest. The objective of the study is to share our experience of the gradual transition from performing the procedure under total circulatory arrest to conducting it under beating heart cardiopulmonary bypass and to emphasise the benefits of the latter.

Methods

From January 2015 to December 2022, 66 consecutive patients who underwent pulmonary thromboendarterectomy were retrospectively analysed and included in the study. Pulmonary endarterectomy under beating heart cardiopulmonary bypass was performed at 30o C with several technical modifications such as the use of three specialised cardiotomy suction tips, balloon occlusion of the opposite pulmonary artery, innominate vein cannulation, transient low flows in difficult areas etc. The patients were followed up with clinical assessment, two-dimensional echocardiography, and computed tomography pulmonary angiogram.

Results

Pulmonary endarterectomy was performed under total circulatory arrest in 30 patients, with arrested heart but without circulatory arrest in five patients, and on beating heart in 31 patients. Majority had Jamieson type 2 disease (53.12%). The beating heart endarterectomy was associated with shorter cardiopulmonary bypass time, less ventilator and inotropic support, improved neurological outcomes, faster recovery and discharge, yet there was no compromise in the clearance of the disease. There were three mortalities (4.54%).

Conclusion

Pulmonary thromboendarterectomy under beating heart cardiopulmonary bypass is an excellent option with good short-term surgical outcomes. Adverse effects of total circulatory arrest can be avoided without compromising the beneficial outcomes.