Pulmonary thromboendarterectomy (PTE) for Pulmonary Hypertension

Overview
Pulmonary thromboendarterectomy (PTE) surgery is a potential cure for some people with chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a type of pulmonary hypertension wherein blood clots in pulmonary arteries cause high blood pressure in the lungs.

What does it involve?
To evaluate your candidacy, your doctor will perform several exams such as breathing tests, blood tests, heart function tests, cancer screenings, and imaging scans. Do not be afraid to ask questions about any aspect of the surgery or recovery.

Before PTE surgery, your surgeon may perform a procedure to insert an inferior vena cava (IVC) filter. The IVC filter will prevent any new blood clots from reaching your lungs in the future. The filter is inserted via catheter through an artery in the neck or groin. During IVC placement, you will be awake but sedated, with local anesthetic at the incision site. You may stay in the hospital for up to 24 hours after IVC placement and return to normal activities within a day or two after returning home. Some surgeons favor the use of IVC filters, while some do not.

On the day your PTE surgery is scheduled to take place, you will be given instructions to stop eating a few hours before surgery. When you arrive at the hospital, vital signs will be taken, blood will be drawn for testing, and other tests may be performed on your heart and lungs. When it is time for the surgery, you will receive an intravenous (IV) line and anesthetic medication to make you sleep.

The surgeon will make an incision down the sternum (breastbone) and spread the chest apart with rib spreaders. PTE surgery takes eight to 10 hours. During the surgery, you will be ventilated via cardiopulmonary bypass – a machine that breathes and pumps your blood for you. At times, the bypass machine will be turned off to allow the doctors better access to arteries. The surgeon will carefully dissect and remove each blood clot. To prevent tissue damage while the bypass machine is turned off, your body will be cooled to 65 degrees Fahrenheit.

Once the blood clots have been removed, your body will be warmed back to normal temperature. Then blood flow will be restored. Finally, the surgeon will close the chest and incisions.

When you wake up after surgery, you will likely be attached to several tubes. You may have one or more tubes in your chest to drain fluids as you heal. You will have a breathing tube, an IV for fluids and medicines, and possibly an epidural in your spine to deliver pain medication. You will have a catheter to drain your bladder. The breathing tube may be removed when you awaken, but the other tubes will likely remain in place for one or more days as you recover. You can expect to spend three to 10 days in the intensive care unit (ICU), then transition to a medical floor for a few more days. After you leave the hospital, you may need to remain available for frequent tests to monitor your recovery for the next few days.

A nurse or doctor will explain how to care for your wound or wounds before you leave the hospital. For eight weeks, do not lift anything that weighs more than five to 10 pounds. It may take several months to fully recover from PTE surgery. You will be scanned to check for new blood clots at six and 12 months after surgery.

Intended Outcomes
In the right candidate, PTE surgery can permanently cure CTEPH.

Results
PTE surgery results in a cure for CTEPH for approximately two-thirds of those who undergo it.

Constraints
The mortality rate for PTE surgery is approximately 5 to 10 percent.

Pulmonary hypertension persists in 10 to 15 percent of those who undergo PTE. In cases of persistent CTEPH, PTE may still furnish some improvement in symptoms.

You will likely require supplemental oxygen for several months after surgery, even if you did not need it before surgery, while the lungs heal.

You must take anticoagulation medication (blood thinners) for the rest of your life to ensure that blood clots do not recur.

Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.

Possible complications of IVC filter and the placement procedure can include an allergic reaction to contrast dye, injury to a blood vessel, or shifting of the filter that requires additional procedures to repair. In rare cases, an IVC filter can actually cause new clots to form.

PTE surgery can be painful, and you will most likely need pain medication for some weeks during recovery.

Call your doctor immediately if you notice signs of infection such as swelling, redness, increased pain, or bleeding from the surgical wound.

For more details about this treatment, visit:
PTE (Pulmonary Thromboendarterectomy) Surgery – Pulmonary Hypertension R.N.
http://pulmonaryhypertensionrn.com/pte-pulmonar...

Pulmonary Thromboendarterectomy – Pulmonary Hypertension Association
https://phassociation.org/cteph/pte-surgery/

PHPN: Post-Pulmonary Endarterectomy: What to Expect During the First Year and How to Handle the Unexpected – PHA Online University
http://www.phaonlineuniv.org/Journal/Article.cf...

Inferior Vena Cava (IVC) Filters – University of Michigan Medical School
http://surgery.med.umich.edu/vascular/patient/t...