Original ArticlesReoperative pulmonary thromboendarterectomy
Section snippets
Patients and methods
Between November 1989 and December 1998, 870 consecutive PTEs for chronic thromboembolic pulmonary hypertension were performed by two surgeons at the University of California, San Diego Medical Center. During this period, 13 patients (1.5%) underwent repeat PTE. Reoperated patients were contrasted with a consecutive cohort of 225 control patients who underwent primary PTE between March 1996 and December 1997, and for whom complete hemodynamic data were available.
Our routine preoperative
Patient demographics
Preoperative and postoperative data for redo and primary patients are displayed in Table 1, Table 2. Seven reoperated patients were men and 6 were women. This distribution did not differ from the control group (111 men and 114 women). Reoperated patients were younger (39 ± 15 years, range 20 to 69 years) than the reference population (53 ± 15 years, range 16 to 85 years) (p < 0.01).
Nine of the 13 (69%) redo patients received their initial PTE operation elsewhere. This operation was unilateral
Comment
Acute pulmonary thromboembolism is a more common condition than is generally appreciated, and in many cases, is asymptomatic until end-stage debilitating pulmonary hypertension develops. In the majority of patients, spontaneous resolution of acute pulmonary embolism is the rule. However, a small but uncertain percentage develop chronic thromboembolic pulmonary hypertension for which medical therapy is ineffective 3, 4, leaving surgical intervention the only definitive option 7, 8, 9, 16, 17.
The
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