Pulmonary Endoarterectomy without Circulatory Arrest and Deep Hypothermia

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By Sofia Martin Suarez, MD, Piero Maria Mikus, MD, Giorgio Arpesella, MD, Elisa Mikus, MD, Emanuele Pilato, MD, and Saverio Pastore

Pulmonary endoarterectomy (PEA) is the treatment of choice in patients with chronic thromboembolic pulmonary hypertension. Traditionally, PEA is achieved by adopting periods of deep hypothermia at 18 degrees Celsius and circulatory arrest.

We present an alternative strategy, based on the application of a negative pressure in the left chambers and also in the superior vena cava to guarantee optimal azygos vein drainage. This makes it possible to avoid deep hypothermic circulatory arrest but achieves a bloodless surgical field. However, if needed, the core temperature may be lowered and circulatory arrest achieved.

The video shows how we surgically manage this pathology. It is very interesting to note that the PEA performed in the right pulmonary artery did not require circulatory arrest and in the left side it was achieved just for few minutes. That demonstrates the versatility of our technique. The extremely reduced back flow does not jeopardize the radical thrombus removal and the anatomic specimens confirm the efficacy of the technique. The avoidance or at least dramatic reduction of deep hypothermic circulatory arrest period is an obvious advantage. 

Video

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Pulmonary Endoarterectomy without Circulatory Arrest and Deep Hypothermia