Pulmonary thromboendarterectomy (PTE) is a major surgery on the blood vessels in the lungs. It involves removing a blood clot from the lung to restore blood pressure levels. PTE is also known as pulmonary endarterectomy.

Doctors may recommend PTE to treat chronic thromboembolic pulmonary hypertension (CTEPH). This rare type of high blood pressure in the lungs occurs due to blood clots that do not dissolve, causing scar-like tissue that blocks small blood vessels.

This article explains what PTE involves, including its benefits, how to prepare for surgery, and more.

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PTE requires general anesthesia and a heart-lung machine, which allows a surgeon to stop the heart but keep blood moving around the body. The surgeon usually stops the heart for 20-minute periods.

The surgeon makes a cut in the chest and opens the arteries that carry blood from the heart to the lungs, known as the pulmonary arteries. They will carefully remove the clots from the arteries using special instruments.

The surgeon closes the incision and takes the individual off the heart-lung machine.

PTE is the most effective nontransplant treatment for chronic thromboembolic pulmonary hypertension (CTEPH). This condition causes repeated blood clots that clog arteries in the lungs, affecting how hard the heart’s right side has to work to pump blood through the area.

However, not everyone with CTEPH is a suitable candidate for PTE. For example, some people have clots that are hard to reach, making surgery more difficult.

The surgery might cause problems for people with pacemakers or those who already have catheters or shunts to expand the blood vessels.

PTE may also be unsuitable for those with end stage lung disease or terminal cancer.

The main benefit of a successful PTE surgery is its ability to relieve pressure on the right side of the heart.

It can also have the following positive effects for those with CTEPH:

  • improved heart function
  • improved blood flow
  • increased tolerance for exercise or physical activity

A person may need to stop taking medication before the procedure. This includes blood-thinning medications, or anticoagulants, such as warfarin.

A person’s doctor can advise on when they may need to stop taking their medication. They can also let them know when they can last eat and drink before the procedure.

Most hospitals do not specialize in PTE. It is important to choose a center that offers a medical team with significant experience in these procedures.

It can also help to have a consultation with a cardiologist, who is a doctor who specializes in heart health, and a cardiothoracic surgeon, who specializes in the chest and heart. They can discuss the risks and benefits of the surgery. They may make recommendations around prepping the home for recovery, stopping certain medications, and when to fast.

People who undergo a PTE will usually require a hospital stay for around 2 weeks.

Upon waking from surgery, an individual may notice that their breathlessness will feel better right away. They may feel pain due to the surgical cut and the stitches in the breast bone.

Recovery usually takes around 2 months. During this time, people should avoid:

  • lifting objects heavier than 10 pounds
  • driving
  • getting moisture on the wound, including through swimming or bathing

People may also need to take blood-thinning medications following PTE.

As with any procedure, there is a risk of complications. Possible risks of PTE surgery include fluid buildup in the tissue layer that surrounds the heart, known as cardiac tamponade.

When the blood re-enters the lungs after a PTE procedure, it can also cause injury, which is known as reperfusion injury. It can lead to fluid in the lungs and low oxygen immediately after surgery.

There is also a risk of brain damage due to stroke as a result of the procedure. Some people may also experience ongoing high blood pressure in the lungs, even after the procedure.

Here are common answers to common questions about PTE.

What is the survival rate for pulmonary thromboendarterectomy?

Over time, the survival rate of PTE has significantly improved. For example, the procedure first became available in the UK in 1997, and a 2022 study examined the survival rates across the 2,116 PTE surgeries that took place over 23 years. In 1997, 12.3% of those who received PTE died within 30 days of surgery, but this rate reduced to 1.9% by 2022.

What is the difference between pulmonary embolectomy and thromboendarterectomy?

Pulmonary embolectomy (PE) is an emergency treatment for pulmonary embolism.

PTE treats the chronic or ongoing form of the condition. Surgeons do not typically consider this an emergency procedure.

How serious is PTE surgery?

PTE surgery is a complex and challenging surgery that involves mechanically stopping the heart for short periods.

A person can discuss the benefits and possible risks with their doctor to reach an informed decision about their treatment for CTEPH.

What is the life expectancy of a person with CTEPH without surgery?

Without treatment, people with CTEPH may have a 3-year mortality rate of around 90%. Over time, CTEPH may make the heart muscles weak, cause fluid buildup, and contribute to heart failure, making the condition typically fatal for those who do not receive treatment.

Pulmonary thromboendarterectomy (PTE) is a treatment for chronic thromboembolic pulmonary hypertension (CTEPH). It involves opening an individual’s chest, stopping the heart for short periods, and removing blood clots from the blood vessels in the lung.

PTE is a challenging procedure. People who are suitable candidates for PTE need to choose a health center that specializes in the surgery. The procedure may improve heart function and restore breathing.