Critical analysis of surgical pulmonary chronic embolectomy: actual technique and late results

RESUMO

After the onset of acute pulmonary embolism, in the majority of the cases, lysis occurs whit recanalization of the pulmonary branches. However, in a small but undetermined number of patients with chronic pulmonary embolism, the incomplete resolution of the emboli material may result in severe pulmonary hypertension. The pulmonary thromboendarterectomy is a therapeutic option, specially when there is proximal obstruction and the clinical treatment fails. Many surgical techniques have been used but sternotomy, extracorporeal circulation and hypothermic circulatory arrest presented with the best results insofar. Until January/95, 15 patients with chronic pulmonary embolism were operated on. The pulmonary angiography showed pulmonary embolism in both lungs in 66.7 percent of the cases. Sternotomy was performed in 73.3 percent. Endarterectomy by retrograde traction of the thrombus was used in all the patients. Extracorporeal circulation was utilized in all patients, With median operative times of 124.8 min. In 66.7 percent of the cases hypothermic circulatory arrest with median operative times of 34.2 min. The pulmonary artery pressure was 91/32/55 mm Hg preoperatively and was reduced to 52/15/27 mm Hg in the postoperative period. One hospital death occurred due to coagulapathy and one late deathe as result complications not related to surgery itself were registered. Of the 13 survivors, 1 (7.7 percent) present reobstruction and 12 (92.3 percent) had favorable outcome and are now free of symptoms under oral anticoagulation, up to 165 months. In conclusion, the pulmonary thromboendarterectomy done through a sternotomy under hypotheremic circulatory arrest is a safe procedure for resolution of pulmonary embolism and symptoms and such results are sustained at long term.