Pulmonary thromboendarterectomy combined with other cardiac operations: Indications, surgical approach, and outcome

Background. Patients with pulmonary hypertension due to chronic thromboembo lic disease benefit from pulmonary thromboendarterectomy. A subset of these patients present with concomitant coronary or valvular disease. Methods. From July 1990 to July 2000, 90 patients (68 males, 22 females, me an age 68 years) with pulmonary vascular resistance (PVR) ranging from 297 to 2261 dynes (.) sec (.) cm(-5) underwent pulmonary thromboendarterectomy in conjunction with coronary bypass grafting (59 patients), coronary artery bypass grafting/foramen ovale closure (24 patients), tricuspid annuloplast y (3 patients), mitral valve repair (2 patients), and aortic valve replacem ent (2 patients). The perioperative and hemodynamic outcomes of these patie nts were compared with the cohort of 1,100 isolated pulmonary thromboendart erectomies performed at our institution during this time. Results. Overall perioperative survival (93.3%; 84 of 90 patients) and mean diminution in PVR (521 (.) dynes (.) sec (.) cm(-5)) for patients undergoi ng combined operations were similar to those undergoing pulmonary thromboen darterectomy alone (94.2% survival; 1034 of 1100 patients; 547 dynes (.) se c (.) cm(-5) mean PVR reduction). Although patients undergoing combined ope rations were older (mean age 68 vs 50 years, p < 0.0001), had longer hospit al stays (median 14 vs 9 days), and had worse left ventricular function (me an preoperative cardiac output 3.1 vs 4.4, p < 0.0001), there was no differ ence in cross-clamp time, resolution of tricuspid regurgitation, or postope rative systolic function between these two groups. Conclusions. Pulmonary thromboendarterectomy for chronic thromboembolic pul monary hypertension may be performed safely in conjunction with other cardi ac operations. Older patients evaluated for pulmonary thromboendarterectomy should be screened for concomitant coronary and valvular disease. (C) 2001 by The Society of Thoracic Surgeons.