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Pulmonary thromboendarterectomy almost 50 years after the first surgical attempts
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  1. I Cerveri1,
  2. A M D’Armini2,
  3. M Viganò2
  1. 1Division of Respiratory Diseases, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
  2. 2Department of Surgery and Organ Transplantation – Division of Cardiac Surgery, IRCCS Policlinico San Matteo University of Pavia, Italy
  1. Correspondence to:
    Dr Isa Cerveri, Clinica Malattie Apparato Respiratorio, Via Taramelli 5, 27100 Pavia, Italy;
    i.cerveri{at}libero.it

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With increased experience in preoperative evaluation, surgical approach and postoperative care of chronic thromboembolic pulmonary hypertension, pulmonary thromboendarterectomy can be performed with an acceptably low risk of death. Most patients, even those in a very compromised state, have excellent, long lasting results

Chronic thromboembolic obstruction of the major pulmonary arteries is a potential long term consequence of acute pulmonary embolism.1 The actual prevalence of chronic thromboembolic pulmonary hypertension (CTEPH) is almost certainly underestimated.2 It is the only type of pulmonary hypertension that can be successfully treated with conservative surgery—that is, pulmonary thromboendarterectomy (PTE)—in selected patients.2–4 CTEPH of sufficient severity to warrant surgical intervention is much more common than previously suspected. Each year there are 500–2500 patients with this condition in the USA, accounting for 0.1–0.5% of patients with pulmonary emboli who survive.3

The PTE operation, as first performed at the University of California, San Diego,5 is now being systematically employed in about 10 centres around the world. Despite this, we concur with Jamieson’s editorial, published four years ago, which stated: “many physicians are unaware that a corrective operation exists, and rely instead on referral for transplantation or merely palliative medical treatment”.2 There is need for a widespread increase in awareness of both the prevalence of this condition and the possibility of a conservative surgical cure.

PTE can be successfully performed in selected centres with a multidisciplinary approach involving the specialities of surgery, pulmonary medicine, critical care, cardiology, anaesthesiology, and radiology.3,4 In our experience, having an active lung transplant programme in the same centre with the same surgeons is a further, substantial advantage, as patients affected by CTPH can be offered all possible options and, in the case of unsuccessful PTE, an effective surgical alternative.6,7

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