PMID- 12754032
OWN - NLM
STAT- MEDLINE
DCOM- 20030814
LR  - 20190513
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 23
IP  - 5
DP  - 2003 May
TI  - Technical advances of pulmonary thromboendarterectomy for chronic thromboembolic 
      pulmonary hypertension.
PG  - 776-81; discussion 781
AB  - OBJECTIVE: To minimize the side-effects of circulatory arrest times and profound 
      hypothermia in patients undergoing pulmonary thromboendarterectomy (PTE) for 
      chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: Between March 
      2000 and June 2002, 30 patients (in New York Heart Association (NYHA) class III 
      or IV) were operated for CTEPH using our modified technique. It includes moderate 
      hypothermic (28-32 degrees C), total cardiopulmonary bypass (CPB) and 
      simultaneous selective antegrade cerebral perfusion and occlusion of the 
      bronchial arteries by introducing an occlusive balloon catheter into the 
      descending aorta. The preoperative pulmonary vascular resistance in the cohort 
      was 873+/-248dynes/s/cm(-5). RESULTS: Mean total CPB, cross-clamp times and 
      duration of anterograde cerebral perfusion were 132+/-40, 98+/-21 and 21+/-10min, 
      respectively. Mean core temperature 29.5+/-1.9 degrees C. The duration of 
      postoperative mechanical ventilatory support was 34+/-44h and the mean stay in 
      the ICU was 5+/-9 days. Seven patients had mild to moderate lung reperfusion 
      injury, one transient neurological dysfunction. Three patients (10%) died during 
      their hospital stay, two for multiorgan failure and one for persistent pulmonary 
      hypertension. All patients had a significant pulmonary hemodynamic improvement 
      and all achieved NYHA class I (P<0.01) status 4 weeks after discharge, remaining 
      stable at a median follow-up time of 16 months (range, 1-29 months) 
      postoperatively. CONCLUSIONS: These technical advances improve neurological 
      outcome, control back-bleeding from bronchial arteries and avoid prolonged 
      rewarming phases in patients undergoing PTE.
FAU - Hagl, Christian
AU  - Hagl C
AD  - Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, 
      Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
FAU - Khaladj, Nawid
AU  - Khaladj N
FAU - Peters, Tina
AU  - Peters T
FAU - Hoeper, Marius M
AU  - Hoeper MM
FAU - Logemann, Frank
AU  - Logemann F
FAU - Haverich, Axel
AU  - Haverich A
FAU - Macchiarini, Paolo
AU  - Macchiarini P
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Chronic Disease
MH  - Cohort Studies
MH  - Critical Care/methods
MH  - Endarterectomy/*methods
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/*surgery
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Postoperative Care/methods
MH  - Preoperative Care/methods
MH  - Pulmonary Embolism/*surgery
EDAT- 2003/05/20 05:00
MHDA- 2003/08/15 05:00
CRDT- 2003/05/20 05:00
PHST- 2003/05/20 05:00 [pubmed]
PHST- 2003/08/15 05:00 [medline]
PHST- 2003/05/20 05:00 [entrez]
AID - S1010794003000290 [pii]
AID - 10.1016/s1010-7940(03)00029-0 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2003 May;23(5):776-81; discussion 781. doi: 
      10.1016/s1010-7940(03)00029-0.