SPC365

Breaking New Ground in Pulmonary Endarterectomy: Initial Experience of a Portuguese Single Center

Session: SESSÃO DE POSTERS 14 - CONGÉNITOS E HTP 2
Speaker: Daniel Inácio Cazeiro

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type: Cartazes
FP Number: ---
Authors: Daniel Inácio Cazeiro; Miguel Azaredo Raposo; Ana Abrantes; Diogo Ferreira; João Cravo; Marta Vilela; Tatiana Guimarães; Nuno Lousada; Ângelo Nobre; Fausto J. Pinto; Ricardo Ferreira; Rui Plácido

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><br />
<span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Pulmonary thromboendarterectomy (PEA) is the main treatment option in operable chronic thromboembolic pulmonary hypertension (PH). We developed a PEA program in collaboration with an international surgical reference center, and hereby present the results of the first 7 patients (pts) treated.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><br />
<span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Retrospective analysis of all pts submitted to PEA. Diagnosis, operability assessment and referral for PEA were carried out by a multidisciplinary team in our PH center. The same surgical team performed all PEA, using cardiopulmonary bypass and deep hypothermic circulatory arrest.</span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong> </strong></span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Postoperatively, pts were managed in the Cardiothoracic Surgery Intensive Care Unit (ICU).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">:</span></span></span><br />
<span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Seven pts (71% female, mean age 69 years and BMI 26kg/m</span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">) underwent PEA. All pts were in WHO functional class (FC) II or III, with a median NTproBNP level of 2218pg/mL and mean 6-minute walking distance (6MWD) of 199m. Seventy-one percent of pts had experienced &ge;1 acute pulmonary embolism. Four pts were on &ge;1 vasodilator and 3 were on long-term oxygen therapy. Mean estimated systolic pulmonary artery pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE) and TAPSE/sPAP ratio were 77mmHg, 18mm and 0.27mm/mmHg, respectively. Most pts exhibited a high-risk hemodynamic profile, with mean mean PAP, pulmonary vascular resistance and cardiac index of 45mmHg, 9.4WU and 2.26L/min/m2, respectively. PEA was performed electively in 6 pts and urgently in 1 pt. Mean bypass time was 281min, with cross-clamp time of 65min and circulatory arrest time of 34min. In the first 6 pts (1 pt still admitted in the ICU), no pulmonary major complications occurred. Two pts experienced major bleeding events and 1 of them had Dressler syndrome, requiring pericardiocentesis. Median ICU and total hospital stay were 5 and 10 days, respectively, with no in-hospital deaths. At present, follow-up consult was performed in 5 pts, with 3 reporting WHO FC improvement and 2 showing decreased NTproBNP levels. Follow-up diagnostic exams were performed in only 1 pt, with an increase in 6MWD (340&gt;432m) and normalization of sPAP and right ventricular function. One pt died 5 months post-surgery from COVID-19 pneumonia.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">: </span></span></span><br />
<span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Seven PEA procedures were carried out successfully in our center, with no in-hospital deaths. Due to the complexity and steep learning curve of the technique, careful patient selection, thorough preoperative planning, and expert collaboration were crucial for a positive outcome.</span></span></span></p>