Technical advances of pulmonary thromboendarterectomy for XXXX .

@entity1 @entity120 @entity177 @entity51 @entity2332
OBJECTIVE: To minimize the side-effects of circulatory arrest times and profound @entity2332 in @entity1 undergoing pulmonary thromboendarterectomy (PTE) for @entity120 ( @entity120 ). METHODS: Between March 2000 and June 2002, 30 @entity1 (in New York Heart Association (NYHA) class III or IV) were operated for @entity120 using our modified technique. It includes moderate hypothermic (28-32 degrees C), total cardiopulmonary bypass (CPB) and simultaneous selective antegrade cerebral perfusion and occlusion of the bronchial arteries by introducing an occlusive balloon catheter into the descending aorta. The preoperative pulmonary vascular resistance in the cohort was 873+/-248dynes/s/cm(-5). RESULTS: Mean total CPB, cross-clamp times and duration of anterograde cerebral perfusion were 132+/-40, 98+/-21 and 21+/-10min, respectively. Mean core temperature 29.5+/-1.9 degrees C. The duration of postoperative mechanical ventilatory support was 34+/-44h and the mean stay in the ICU was 5+/-9 days. Seven @entity1 had mild to moderate lung reperfusion injury, one transient @entity51 . Three @entity1 (10%) died during their hospital stay, two for @entity177 and one for persistent @entity120 . All @entity1 had a significant pulmonary hemodynamic improvement and all achieved NYHA class I (P<0.01) status 4 weeks after discharge, remaining stable at a median follow-up time of 16 months (range, 1-29 months) postoperatively. CONCLUSIONS: These technical advances improve neurological outcome, control back-bleeding from bronchial arteries and avoid prolonged rewarming phases in @entity1 undergoing PTE.
