Chronic thromboembolic pulmonary hypertension (CTEPH) is when patients accumulate old clots and scar tissue within the arteries of the lung.
These clots and tissue block blood flow, causing high blood pressure in the lungs (pulmonary hypertension), difficulty breathing and heart failure. For patients with CTEPH, pulmonary thromboendarterectomy surgery is a lifesaving surgery that improves breathing, heart function, and quality of life.
Pulmonary thromboendarterectomy (PTE) it is a complex surgical procedure that clears old blood clots (thrombi) and scar tissue from the arteries in the lungs. These clots and tissue, which have often become lodged in the lung and hardened over time, block blood flow and cause high blood pressure in the pulmonary arteries. This increased pressure puts a strain on the right side of the heart, which can eventually lead to heart failure if left untreated.
PTE is the definitive treatment for CTEPH, and it is the only therapy providing cure of CTEPH. Old clots in the lung, unlike new blood clots, can’t dissolve on their own. Instead, they scar and narrow the blood vessels, leading to increased pressure in the pulmonary arteries. This increased pressure puts a strain on the right side of the heart, which can eventually lead to heart failure if left untreated. PTE surgery, by clearing out old clots and scar tissue, will reopen clogged arteries in the lung and improve breathing and cure pulmonary hypertension and heart failure.
Choosing AHN for your PTE and CTEPH care means receiving a broad array of advanced diagnostic and therapeutic options that will be tailored to your specific health needs. These progressive care options are delivered by a multidisciplinary team of highly skilled surgeons, cardiologists, and health care professionals who work together to navigate these complex conditions. This leads to better health outcomes for our patients through our focus on:
Undergoing a major surgery like PTE can bring many questions and anxieties. Our goal at AHN is to provide you with a clear understanding of what to expect before, during, and immediately after your procedure, helping you feel more prepared and informed every step of the way. Your AHN care team is dedicated to guiding you through this process with the highest level of support and expertise.
PTE surgery is performed in a hospital setting, specifically at specialized medical centers equipped for complex cardiac and pulmonary procedures, like at AHN. There will be important preparation steps leading up to your surgery date. This often includes preadmission testing, medical clearances, medication review, and lifestyle adjustments.
You will be preadmitted two days prior to your surgery to allow for time to further improve your medical readiness prior to surgery and to transition off your home oral blood thinners. This allows your care team to begin the preoperative steps to help you have a successful surgery. You will meet with members of your surgical team, including your surgeon, anesthesiologist, and nurses, who will answer any last-minute questions and review the procedure.
The surgical procedure is done under anesthesia and is a complex, hours-long operation. Here’s what to expect, generally:
A PTE surgery is a complex procedure and typically lasts between eight to 10 hours or more, depending on the individual's anatomy and the complexity of the clot removal. This time includes preparation for surgery, the procedure itself, and initial recovery in the operating room.
The recovery process after PTE surgery is significant and requires time, patience, and adherence to medical guidance. While it is a major surgery, many patients experience a remarkable improvement in their quality of life and functional capacity after successful PTE. The recovery can be broadly divided into several phases: immediately post-op, hospital stay, and home recovery.
Immediately after PTE surgery, you will be transferred to the intensive care unit (ICU), where you will receive continuous, close monitoring. This phase typically lasts for a few days. In the ICU, your care and support team will monitor:
Once it’s been determined you are stable enough to move out of the ICU, you will move to the step down unit, where your additional recovery will continue. Total hospital stay can range from 10 to 14 days, but that is dependent on your specific recovery. In the hospital, you will be monitored to ensure continued recovery and supported in the following ways:
Pulmonary thromboendarterectomy (PTE) is a complex and involved surgery. Your AHN care and surgical team are here to guide you through the specifics involving your particular case and will be available to answer any and all questions that you may have. In the meantime, to help provide a base understanding that may help in your future conversations, we’ve included some of our patients’ most frequently asked questions.
Advancements in treatments have significantly improved the life expectancy for individuals with CTEPH. For those who are surgical candidates, PTE surgery can be an excellent option, with many patients achieving near-normal life expectancy. For those who are not surgical candidates or where surgery isn’t a complete cure, medical therapies and balloon pulmonary angioplasty (BPA, using balloons to open up blocked arteries in the lungs) can also improve quality of life and prognosis, though their life expectancy may still be somewhat reduced compared to the general population. Regular monitoring and adherence to treatment plans are crucial for optimizing outcomes.
Yes, pulmonary thromboendarterectomy (PTE) is considered a major and complex surgery. It is an open-heart procedure performed under general anesthesia, requiring a sternotomy (an incision through the breastbone), heart-lung bypass support, deep hypothermia (cooling the body to a very low temperature), and temporary circulatory arrest. The goal is to remove old blood clots and scar tissue from the pulmonary arteries. Due to its complexity, PTE is typically performed at highly specialized centers by experienced surgical teams, like those at AHN.
Candidates for PTE surgery are carefully selected based on several criteria. Generally, eligible patients have:
A multidisciplinary AHN team, including cardiologists, pulmonologists, and cardiothoracic surgeons specializing in PTE, evaluates each patient to determine candidacy.
If you haven’t formally been diagnosed, call (412) DOCTORS 412-362-8677 or request an appointment with AHN cardiovascular services.
If you have been diagnosed, please call 412-442-2450 to contact the CTEPH coordinator.
