| Abstract
| - Some patients with chronic pulmonary embolism causing severelysymptomatic pulmonary hypertension have been managed by heart-lungtransplantation with an associated hospital mortality of 24%. To allowcomparison with pulmonary thromboendarterectomy (PTE), we have reviewed thehospital morbidity and mortality in 149 consecutive patients. From 1October 1984 to 18 September 1989, these patients underwent PTE utilizing astandardized procedure consisting of median sternotomy, cardiopulmonarybypass, deep hypothermia and circulatory arrest for bilateral PTE in 91%(136/149) of the procedures with 7.4% (11/149) and 1.3% (2/149) undergoingright or left PTE, respectively. Ventilator dependency (greater than orequal to 5 days on respirator) occurred in 28.3% (41/146). Hospitalmortality (death within 30 days or in hospital) was 11.4% (17/149). Themost common causes of death were respiratory and multiorgan failure, 10(59% of deaths) and acute pulmonary hemorrhage, 3 (17% of deaths). Weconclude that PTE with an operative mortality of half that of heart-lungtransplantation (11.4% vs. 24%) should be the procedure of choice forsignificantly symptomatic chronic pulmonary embolism. Furthermore, thehazards of immunosuppression and chronic graft rejection are avoided.
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