Pulmonary Thromboendarterectomy

Overview

What is pulmonary thromboendarterectomy (PTE) surgery?

PTE is surgery to remove blood clots and scar tissue from the arteries in your lungs. It is also called pulmonary endarterectomy (PEA). This 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 damage to the lungs.

Who can have a pulmonary thromboendarterectomy?

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.

Procedure Details

What happens during a pulmonary thromboendarterectomy?

You will be under anesthesia for the procedure, which generally starts early in the morning and lasts for around six hours.

During the procedure:

  • An endotracheal tube and other tubes/lines will be placed.
  • The surgeon will make an incision in the sternum (breast bone) so that the team can reach your heart and lungs.
  • You will be put onto a heart-lung machine (called cardiopulmonary bypass), which will act as your heart and lungs.
  • 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.
  • At this time, clots are removed with special tools from the arteries.
  • You will be re-warmed to your regular temperature and taken off the bypass machine.
  • Drains will stay in place in the chest to drain fluid, but the chest will be closed.
  • You will be taken from the operating room to the intensive care unit (ICU), where you will remain overnight. It is likely that you will be removed from the ventilator (breathing machine) in the morning after a test showing that you are able to breathe on your own.

What happens after the pulmonary thromboendarterectomy (PTE)?

Plan to stay in the hospital about 10 days. You will start your recovery in an intensive care unit (ICU) and move to a step-down unit as soon as possible — likely the day after surgery. You will probably be able to start walking within a few days and slowly start doing more. You will have tests while you are in the hospital, including a test to find out how much oxygen you will need after you go home.

Risks / Benefits

What is the benefit of a pulmonary thromboendarterectomy (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 a pulmonary thromboendarterectomy (PTE)?

There are risks with any procedure, but experienced teams have a mortality rate of less than 3% . Of course you will have pain to manage immediately after the surgery. A condition called pericardial effusion (fluid build-up around heart) does happen sometimes.

Recovery and Outlook

How long will it take me to recover from a pulmonary thromboendarterectomy?

You will slowly be able to get back to your normal activities, but you will not be able to drive, work or lift anything heavier than 15-20 pounds for at least six weeks after surgery.

You should be able to return to all of your normal activities within three months of surgery.

How will having a pulmonary thromboendarterectomy affect my life?

You will need to have follow-up visits and tests to check your lungs. These tests are usually six weeks and three to six months after surgery. You will also need to take medication to prevent blood clots (a “blood thinner”) for the rest of your life.

Your breathing and ability to exercise will improve, and may continue to improve for up to four years after your surgery.

Some people who have a PTE have pulmonary hypertension (PH) that will not go away, or that returns. If so, your doctor might want you to have a right heart catheterization and take medication to help relieve PH.

When to Call the Doctor

When should I call the doctor after having a pulmonary thromboendarterectomy (PTE)?

You will need to contact 911 or go to the emergency room if any of the following things happen after you go home:

  • Feeling very short of breath very suddenly.
  • Fainting.
  • Chest pains.

The first three might be symptoms of something called pericardial effusion, which means that fluid is building up around the heart. This does happen sometimes.

Other symptoms that mean you should call a doctor include:

  • Extreme pain, or pain that gets worse after having gotten better.
  • Signs of infection like fever, drainage, or redness/tenderness.
  • A fast or irregular heartbeat.

Resources

Where can I find more information about pulmonary thromboendarterectomy (PTE) and chronic pulmonary thromboembolic hypertension (CTEPH)?

Last reviewed by a Cleveland Clinic medical professional on 10/17/2019.

References

  • Pulmonary Hypertension Association. Pulmonary Thromboendarterectomy. (https://phassociation.org/cteph/pte-surgery/) Accessed 12/13/2019.
  • Jamieson SW, Madani MM. Jamieson S.W., Madani M.M. Jamieson, Stuart W., and Michael M. Madani.Pulmonary Embolism and Pulmonary Thromboendarterectomy. In: Cohn LH, Adams DH. Cohn L.H., Adams D.H. Eds. Lawrence H. Cohn, and David H. Adams.eds. Cardiac Surgery in the Adult, 5e New York, NY: McGraw-Hill.
  • Madani MM. Surgical Treatment of Chronic Thromboembolic Pulmonary Hypertension: Pulmonary Thromboendarterectomy. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344471/) Methodist Debakey Cardiovasc J. 2016;12(4):213-218. Accessed 12/13/2019.

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