Pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension

Pulmonary arterial hypertension (PAH) secondary to chronic thromboembolic obstruction is a severe and potentially fatal condition. At the same time, PAH represents a real diagnostic challenge. This is a lethal disease in which the natural progression in the majority of cases may not be modified by medical therapy. It may be the only etiology radically cured by a complex surgical procedure being performed successfully at ten medical centers worldwide: the pulmonary thromboendarterectomy (PTE). More than three decades after the first successful thromboendarterectomy, improvements in technique in medical centers such as the University of California San Diego, in addition to the achieved advances in cerebral and myocardial protection during the past decades, guarantees at present a low morbimortality rate, offering excellent long-term results and improving quality of life and survival of patients. This review is mainly focused on the historical perspective of PTE, indications, patient selection, surgical approach and improvements and outcomes obtained at the most experienced centers worldwide.