Age should not be a barrier for pulmonary endarterectomy in carefully selected patients

Pulmonary endarterectomy (PEA) is the treatment of choice in operable chronic thromboembolic pulmonary hypertension (CTEPH) with excellent long-term outcomes [1]. It is a complex surgical procedure requiring cardiopulmonary bypass and removal of obstructive thromboembolic material during periods of deep hypothermic circulatory arrest [1]. We have observed an increase in the number of older CTEPH patients referred for consideration of PEA, which is consistent with other cardiothoracic surgeries. The UK population is ageing with a projected 3% increase in subjects aged >85 years in the next 20 years [2]. This may be mirrored by patients with CTEPH getting older, as the incidence of pulmonary embolism, which frequently precedes CTEPH, markedly increases with age [3, 4]. Furthermore, an epidemiological analysis by Gall et al. [5] has projected that the annual incidence of CTEPH will increase over the next 10 years. Therefore, the management of CTEPH in older patients is a pertinent topic for investigation. CTEPH patients over 80 years old undergoing pulmonary endarterectomy have similar outcomes to those under 80 years The authors wish to thank the National Pulmonary Hypertension Centres UK and Ireland for referring the patients that were considered for PEA.