Early outcomes of controllable pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a single-centre experience at the Almazov National Medical Research Centre

Objective. To evaluate the early outcomes of original controllable pulmonary thromboendarterectomy (PEA) in the treatment of CTEPH. Material and methods. A single-center cohort retrospective-prospective study enrolled 74 CTEPH patients who underwent PEA between 2018 and 2024. All procedures were performed under deep hypothermic circulatory arrest using a patented method for assessing the completeness of endarterectomy (RF patent RU 2794557 C1). Original technique compares preoperative anatomical “map” of lesion (template No. 1) based on CT angiography and selective pulmonary angiography with intraoperative thromboembolic material placed on a sterile template No. 2. The primary endpoint was >50% reduction in mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR). Invasive assessment was performed immediately after surgery and at discharge. Results. Median age was 52.5 years [43; 65]; 59.2% were male. A total of 73 patients (98.6%) completed the study. Cardiopulmonary bypass time was 216 min [188; 236], circulatory arrest time — 50 min [40; 60]. mPAP decreased by 62% [53.7; 68.2] at discharge from ICU; PVR dropped from 11.45 Wood units [7.4; 14.2] to 1.95 Wood units [1.4; 2.4] (p<0.001). Residual pulmonary hypertension (mPAP ≥25 mmHg and PVR ≥2.5 Wood units) was observed in 9 (12.3%) patients. The six-minute walk distance increased from 347 to 420 m (p<0.001); 85.7% of patients achieved NYHA class I–II. Complications included reperfusion pulmonary edema (41%), reintubation (8.1%), stroke (4.1%), and pneumonia (22.2%). In-hospital mortality was 1.4% (n=1; cause: generalized infection with multiple organ failure). Conclusion. Controllable pulmonary thromboendarterectomy provides objective intraoperative assessment of completeness of PEA without prolonged circulatory arrest time. Hemodynamic, clinical and functional outcomes are consistent with the best international standards. The incidence of residual pulmonary hypertension and mortality do not exceed those of expert centers.