Pulmonary Thromboendarterectomy (PTE)

UC San Diego Health is the worldwide leader in pulmonary thromboendarterectomy (PTE) surgery, also known as pulmonary endarterectomy (PEA), to treat chronic thromboembolic pulmonary hypertension (CTEPH).More about CTEPH and pulmonary hypertension

Developed here at UC San Diego Health, PTE is a complex surgery that removes deadly chronic blood clots from major blood vessels in the lungs that cannot be treated with medication. 

Without treatment, these clots block off blood flow to the lungs, causing damaging vascular changes and pulmonary hypertension. This condition can lead to heart failure and death.

For individuals who are not candidates for PTE surgery, our team also offers balloon pulmonary angioplasty and medical therapy.

Why Choose UC San Diego Health for PTE?

Expert Evaluation

Misdiagnosis or failure to recognize CTEPH is common, leaving many people out of breath with a deadly, but treatable, disease. Our specialists are leaders in evaluating patients with chronic thromboembolic pulmonary hypertension.

Unmatched Volumes and Outcomes

UC San Diego Health boasts more successful PTEs than any other medical center and the lowest post-surgery mortality rate worldwide. Patients with thromboembolic pulmonary hypertension who have not received appropriate diagnosis and treatment at other centers around the world are often treated successfully at our center.

Center of Excellence Designation

Our PTE program is the first to be nationally designated as a Center of Excellence by the American College of Chest Physicians.

We have the highest success rate in the world for pulmonary thromboendarterectomy – performing more PTEs than any other medical center (over 4,000).

Over the past several years the program has maintained a mortality rate of less than 1 percent, with very low morbidity and excellent hemodynamic outcomes. The procedure can reverse heart failure and is considered more effective than lung transplantation.

Over the last several years the PTE program has maintained a mortality rate of less than 1 percent. The procedure can reverse heart failure and is considered more effective than lung transplantation.

Three Goals of PTE Surgery

  1. Improve blood flow (hemodynamics) from the right side of the heart through the pulmonary arteries.
  2. Improve symptoms and quality of life. Enable a clear pathway for the blood to engage in normal gas exchange so you can breathe easier.
  3. Prevent heart failure and premature death. Alleviate stress on the right side of the heart by correcting pulmonary hypertension.

What Happens During PTE Surgery?

PTE is an 8- to 10-hour procedure that involves opening the chest and attaching the patient to a heart-lung bypass machine, then cooling the patient’s body to about 64-68 degrees Fahrenheit. The cold temperature reduces the body's need for oxygen and provides organ protection during this unique surgery. 

For the critical parts of the surgery, the surgeons turn off the heart-lung machine, stopping circulation for up to 20 minutes, to create a bloodless surgical field. Then the surgeons open the arteries blocked by chronic clots and scar tissue. They repeat the on-off process with the heart-lung bypass machine until all of the obstructing material is removed.

Who Is a Candidate for PTE?

People as young as 8 and as old as 89, as well as those with complex coexisting conditions, have successfully undergone PTE surgery at UC San Diego Health. 

Patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are turned down at other centers are often treated successfully at UC San Diego Health. Accordingly, we often have a very different opinion than the rest of the world when it comes to operability and surgical candidacy.

In addition, in experienced centers the PTE operation has a lower operative mortality rate than lung transplantation. PTE can also be done electively without waiting for a donor and without the potential long-term problems associated with rejection and immunosuppressive drugs following transplantation.

Who is Not a Candidate for PTE?

If a patient has a disease or condition unrelated to pulmonary hypertension that would limit his or her near-term survival, PTE may not be advised. A patient with severe pulmonary fibrosis along with CTEPH, for example, may be a candidate for lung transplantation rather than PTE. The determination of operability often, and ideally, has to be done in person and with a series of specialized tests at a center experienced in CTEPH and PTE.

Personalized Care at UC San Diego Health

We pride ourselves on giving personal attention to each patient and their family members. We will work closely with your personal physician so that when you return home, your doctor will have a thorough understanding of the care you received at UC San Diego Health, as well as the follow-up regimen required.Preparing for PTE