Pulmonary Endarterectomy (PEA) is an life-saving surgical procedure that is designed to remove blood clots (chronic thromboembolic material) from pulmonary arterial. The clots may stop blood flow to the lungs and lead to chronic thromboembolic hypertension (CTEPH) -an extremely serious condition which can lead to heart failure if untreated.
PEA is regarded as the most effective treatment option for patients with CTEPH. Understanding the different kinds of techniques for Pulmonary Endarterectomy aids in determining the most effective treatment for the specific patient’s situation.
What is Pulmonary Endarterectomy?
Pulmonary Endarterectomy (E.T.) is a skilled surgical procedure, carried out under cardiopulmonary bypass as well as the deep hypothermic circulation arrest. It involves removing scar-like clots in the pulmonary arteries in order to restore blood flow to normal and to reduce pressure inside the lung.
Why Pulmonary Endarterectomy is Performed
CTEPH is found in 3-4 percent of patients with an embolism pulmonary (PE). As time passes, emboli that are not treated transform into fibrotic tissue, which can block or narrow the pulmonary vessels. This results in increased pulmonary vascular resistance and puts pressure upon the right heart.
If not treated, CTEPH can result in:
- Heart failure of the right side
- Breath shortness that is progressive
- The reduction in oxygenation
- Life quality is less
- Early death
Pulmonary Endarterectomy may be the sole treatment that can cure CTEPH which is why it is crucial to be aware of its different forms.
Types of Pulmonary Endarterectomy
There are many methods and modifications to the procedure of Pulmonary Endarterectomy, based on:
- The size and location of burden from clots
- The patient’s health status in terms of cardiovascular
- The surgical expertise available is
Let’s look at the most common kinds:
Standard Bilateral Pulmonary Endarterectomy
It is the most commonly used and most commonly utilized method for patients with CTEPH.
Procedure Details:
- The procedure is performed by the median sternotomy (a vertical cut in the chest).
- requires cardiopulmonary bypass and the deep hypothermic circulation arrest (DHCA) for a short time to block circulation and lower the body’s temperature (~18degC).
- The surgeon reaches the pulmonary veins on both sides and eliminates thromboembolic tissue layer by layer with precise dissection.
Ideal For:
- Patients who have bilateral disease involving principal, lobar and segmental arteries.
Benefits:
- Proven long-term outcomes
- Normalization of pulmonary pressure
- Improved quality of life
Unilateral Pulmonary Endarterectomy
In some patients, the condition may be restricted only to one lung. In these cases the possibility of an unilateral PEA could be a possibility.
Procedure Details:
- The procedure is performed via sternotomy or thoracotomy.
- Only one pulmonary arterial (right or left) is cleaned and dissected.
- The use of cardiopulmonary bypass continues frequently together with DHCA.
Ideal For:
- Patients with localized ailment.
- People who aren’t suited for a complete bilateral procedure due to co-morbidities or risk of surgery.
Benefits:
- Lower risk of a surgical procedure
- A shorter recovery time
- The prevention from bilateral arrests of circulation
Minimally Invasive Pulmonary Endarterectomy (MIP)
The technique is still in the experimental phase and is being studied at a few centers. It’s a less-invasive surgical approach that uses video-assisted surgical procedure (VATS) as well as robotic instruments.
Procedure Details:
- Incisions of a small size (keyhole surgery)
- It is possible to use robotic or endoscopic techniques.
- Typically, for patients suffering from distal segmental disease
Ideal For:
- Patients with high-risk who aren’t able to undergo open surgery
- Those with disease in the segmental/subsegmental branches
Benefits:
- Minimal trauma
- Hospitalization in a short time
- Less problems
Limitations:
- Not easily accessible
- Not appropriate for severe or bilateral diseases.
Repeat Pulmonary Endarterectomy (Redo PEA)
Some patients may need another procedure because of a residual illness or a recurrence.
Procedure Details:
- Performs similar to normal PEA
- Preoperative imaging is required to determine the extent of thromboembolic burden remaining
Ideal For:
- Patients who had a clot that was not removed during the initial surgery
- Progressive symptoms despite initial improvement
Challenges:
- More technical because of scar tissue
- Greater risk of surgery
Diagnosis Before Choosing the Type of PEA
Complete diagnostics are crucial prior to surgery:
- Ventilation/Perfusion (V/Q) scan
- CT Pulmonary Angiography (CTPA)
- Right Heart Catheterization
- Pulmonary Angiography
- Echocardiogram
These tests can help identify the exact location and size of blockages. This determines the procedure to be undertaken.
Pulmonary Endarterectomy vs Other Treatments
Although PEA is curative, certain patients might not be surgical candidates. Other options are:
- The Balloon Pulmonary Angioplasty (BPA) is a treatment for distal diseases
- Pulmonary Hypertension Medications (e.g., Riociguat)
- Lung Transplantation – in highly modern, highly functional instances
However, PEA remains the preferred procedure when surgery is feasible.
Recovery and Outcomes
The rate of recovery is based on the nature of the PEA, its general health, and intensity.
The most common results are:
- ICU stay of 1-2 days
- The total hospitalization time is 1 to 2 weeks
- Gradual return to normal activities over 6-8 weeks
Long-Term Benefits:
- Increased pulmonary pressure
- Improved endurance to exercise
- Better life expectancy
Conclusion
Pulmonary Endarterectomy is a transformative procedure for patients suffering from chronic thromboembolic hypertension pulmonary. The decision between standard, unilateral, minimally invasive or redo PEA depends on the degree of the disease, the patient’s suitability and the expertise of the center.
If you or someone close to you has been diagnosed with CTEPH Understanding the different varieties of Pulmonary Endarterectomy will help you get the best treatment and to ask the right questions.
To get the most effective results seek out a specialized Pulmonary Hypertension Center that has an integrated team approach to assess and carry out this difficult but effective treatment.
