Pulmonary artery thromboendarterectomy: A comparison of two different postoperative treatment strategies

Pulmonary artery thromboendarterectomy (PTE) is a potentially curative surg ical procedure for chronic thromboembolic pulmonary hypertension. It is, ne vertheless, associated with considerable mortality caused by postoperative complications, such as reperfusion pulmonary edema (RPE) (i.e., pulmonary i nfiltrates in regions distal to vessels subjected to endarterectomy) and ri ght heart failure (RHF). However, there are no reports about the influence of different postoperative treatment strategies on complications and mortal ity. Therefore, we compared two different treatment strategies. In Group I (n = 33), positive inotropic catecholamines and vasodilators were avoided d uring termination of cardiopulmonary bypass (CPB) and thereafter, and mecha nical ventilation was performed with low tidal volumes < 8 mL/kg, duration of inspiration:duration of expiration = 3:1, and peak inspiratory pressures < 18 cm H2O. In Group II (n = 14), positive inotropic catecholamines and v asodilators were regularly used for termination of CPB and thereafter, and ventilation was performed with high tidal volumes (10-15 mL/kg) and peak in spiratory pressures up to 50 cm H2O. Hemodynamics, the incidence of RPE and RHF, duration of ventilation, morbidity, and mortality were recorded. Card iac index was comparable before surgery (2.11 +/- 0.09 vs 2.08 +/- 0.09 L . min(-1) . m(-2)) and 20 min after CPB (2.26 +/- 0.09 vs 2.60 +/- 0.20 L mi n(-1) m(-2)). RPE occurred in 6.1% (Group I) versus 14.3% (Group II), and R HF was observed in 9.1% (Group I) versus 21.4% (Group II). Mortality was 9. 1% (Group I) versus 21.4% (Group II). Thus, the avoidance of positive inotr opic catecholamines and vasodilators in combination with nonaggressive mech anical ventilation after PTE was associated with a low incidence of RPE, RH F, duration of ventilation, and mortality after PTE. Implications: The avoi dance of positive inotropic catecholamines and vasodilators in combination with nonaggressive mechanical ventilation was associated with a low inciden ce of reperfusion pulmonary edema and/or right heart failure after pulmonar y artery thromboendarterectomy.