Pulmonary Thromboendarterectomy: Three Goals of PTE Surgery
- Improve blood flow (hemodynamics) from the right side of the heart through the pulmonary arteries.
- Improve symptoms and quality of life. Enable a clear pathway for the blood to engage in normal gas exchange so that the patient can breathe easier.
- Prevent heart failure and premature death. Alleviate stress on the right side of the heart by correcting the 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?
Pulmonary hypertension caused by chronic emboli is a “surgical disease,” meaning it is treatable with PTE surgery.
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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. This expansion of the patient population considered candidates for this operation is based largely on UC San Diego’s accumulated surgical experience, improved operative techniques, and multidisciplinary approach to perioperative care. Patients with chronic thromboembolic pulmonary hypertension 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.
We feel that lung transplantation should not be a first option for patients with chronic thromboembolic disease. We consider that treatment to be outdated and potentially unethical as it diverts a precious resource away from another end-stage lung disease patient who could benefit from the organs. Furthermore, 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 concomitant 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.
For individuals who are not candidates for PTE surgery, our team also offers balloon pulmonary angioplasty and medical therapy.
Personalized Care at UC San Diego Health
We pride ourselves on the personal attention given to each patient and his or her family members. Moreover, 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, as well as the follow up regimen required.
Read more about planning your PTE surgery at San Diego Health.