What is pulmonary thromboendarterectomy (PTE)?
This procedure is also called pulmonary endarterectomy (PEA). It is surgery to remove blood clots and scar tissue from the arteries in the lungs. The surgery can potentially cure a condition called chronic thromboembolic pulmonary hypertension (CTEPH).
With CTEPH, blood clots get trapped within the walls of the arteries and develop scar tissue over time. Pressure in the lungs is high and breathing can be difficult. The blockage leads to high pressures in the arteries, eventually leading to right heart failure and lung damage.
Who is eligible for PTE?
If you have CTEPH, your healthcare provider will examine you in order to assess your general level of health. They will also assess your breathing and the damage to your heart. The location of the blockages helps determine whether or not the surgery will be successful.
What happens during PTE?
You will be under anesthesia for the procedure. The procedure is usually done early in the morning and lasts about six hours. After you get the anesthesia:
- An endotracheal tube and other tubes/lines will be put in place.
- The surgeon will make an incision in your sternum (breast bone) to reach your heart and lungs.
- You will be put onto a heart-lung machine (cardiopulmonary bypass), which will act as your heart and lungs during the surgery.
- The bypass machine will also be used to cool you to 65 degrees Fahrenheit (18 degrees Celsius), which is necessary because the machine must be shut off for a brief time during the procedure.
- While your body is cool, the clots are removed from the arteries using special tools.
- You will be re-warmed to your regular temperature and taken off the bypass machine.
- Your chest will be closed, but you will have tubes to drain fluid from your chest.
- You will go to the intensive care unit (ICU), where you will stay overnight. It is likely that you will be removed from the ventilator (breathing machine) in the morning. You will have a test to see if you can breathe on your own.
What happens after PTE?
People who have PTE usually are in the hospital for about 10 days. You will usually be up and walking in a few days. Drains and tubes are removed gradually. We will use medications and other techniques to manage your pain.
You will have a number of tests to check your heart and lungs before you leave the hospital. These include a test to measure how much additional oxygen therapy you need.
You will need to take "blood thinners."
You will be able to gradually resume your activities. You will be asked not to drive, return to work, or lift anything heavier than 15-20 pounds for at least six weeks. You should be able to get back to all of your normal activities about 3 months after PTE.
Your doctor will likely recommend cardiopulmonary rehabilitation. Your breathing and exercise capacity will continue to improve even 12 to 48 months after the surgery.
What is the benefit of PTE?
PTE is really the only way to cure chronic thromboembolic pulmonary hypertension (CTEPH). The surgery is successful in the majority of cases, either relieving breathing issues completely or improving them greatly.
What are the risks of PTE?
There are risks with any procedure, but experienced surgical teams have a mortality rate of less than 3%. Some patients develop a condition called pericardial effusion (fluid build-up around heart). Your surgeon will talk to you before surgery about all the risks and benefits of the procedure.
What is the long-term outlook for patients who have a successful PTE?
Recovery from PTE involves check-ups for lung testing, usually about six weeks and three to six months after your surgery. Some people have pulmonary hypertension (PH) that will not go away or returns. In this case, your doctor might suggest that you have a right heart catheterization and take medication to help your PH.
When should I call the doctor after PTE?
Call 911 or go to the emergency room if you:
- Feel very short of breath very suddenly.
- Faint.
- Have chest pain.
These can be symptoms of pericardial effusion.
Call your doctor if you have:
- Extreme pain or pain that gets better and then worse again.
- Signs of infection like fever, drainage, or redness/tenderness at your incision site.
- Fast heartbeat.
