Anesthetic Experience and Short-Term Outcomes in Our First 29 Pulmonary Endarterectomy Cases

Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable form of pulmonary hypertension caused by organized thromboembolic obstruction of the pulmonary arteries. Advances in surgical and anesthetic techniques have improved outcomes, highlighting the importance of evaluating institutional experience. This study presents our anesthetic management and short-term outcomes in the first 29 patients who underwent pulmonary endarterectomy (PEA) for CTEPH.
Methods: This retrospective, single-center study included 29 patients with CTEPH who underwent PEA between November 2018 and July 2024 at Baskent University Ankara Hospital, Türkiye. Demographic, preoperative, and intraoperative anesthetic data and postoperative outcomes were analyzed. Outcomes included duration of mechanical ventilation, intensive care unit (ICU) and hospital lengths of stay, early and 6-month echocardiographic findings, and mortality. Preoperative and follow-up data were compared, and univariate logistic regression was performed to assess risk factors for in-hospital mortality.
Results: The mean patient age was 55.1±18 years, and 44.8% were male. Preoperative echocardiography revealed a mean EF of 53±12%, mPAP of 85±29.2 mmHg, and TAPSE of 17±4.7 mm. Mean CPB, aortic cross-clamp, and total circulatory arrest durations were 232±64.8, 84±29.7, and 34±15.5 minutes, respectively. Early postoperative echocardiography showed a substantial reduction in mPAP to 45.6±22.9 mmHg, which remained stable at 6 months (44.4±27.9 mmHg). The 6-month mortality rate was 21.5%, with no perioperative variables inde-pendently associated with mortality.
Conclusion: PEA resulted in significant early improvement in pulmonary hemodynamics. Although mortality was higher than that reported by high-volume centers, this likely reflects advanced disease and early institutional experience, consistent with the learning-curve effect described in the literature.

Keywords: Anesthetic management, cardiopulmonary bypass, chronic thromboembolic pulmonary hypertension, pulmonary endarterectomy, right ventricular dysfunction