Early outcomes of pulmonary thromboendarterectomy: A single-center experience

ABSTRACT Background: Pulmonary endarterectomy (PEA) is the definitive or curative surgical treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Despite global advancements, data from India remain limited. This study aims to evaluate the demographic, clinical, operative, and inhospital outcomes of patients undergoing PEA in an Indian tertiary care setting. Materials and Methods: This retrospective single-center observational study included 24 patients who underwent PEA between January 2022 and May 2024. Data on clinical presentation, comorbidities, imaging findings, intraoperative parameters, postoperative complications, and early outcomes were analyzed. Results: The mean patient age was 38.2 ± 11.4 years, with a male predominance (83.3%). Bilateral CTEPH was present in 91.7% of cases. Preoperatively, most patients were in the New York Heart Association (NYHA) Class II (62.5%), and 58.3% had right ventricular dysfunction. The mean cardiopulmonary bypass and circulatory arrest times were 178.7 ± 58.3 and 38.4 ± 19.9 min, respectively. Postoperative complications occurred in 25% of patients, including bleeding (12.5%), infection (12.5%), and cerebrovascular accident (8.3%). Reintubation was required in two patients and tracheostomy three patients. Five (20.8%) patients died, primarily due to right ventricular failure and multiorgan dysfunction. Among survivors, 77.8% improved to NYHA Class I at discharge. Conclusion: Despite the technical complexity and high perioperative risk, pulmonary thromboendarterectomy offers significant symptomatic relief and functional improvement in patients with operable CTEPH. Early referral, meticulous surgical technique, and multidisciplinary perioperative care are critical to optimizing outcomes, particularly in emerging programs in India.