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Eur J Cardiothorac Surg 2006;30:237-241
© 2006 Elsevier Science NL

Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: is deep hypothermia required?

^a Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
^b Department of General Thoracic Surgery, Thoracic Clinical Institute, Hospital Clinic of Barcelona, University of Barcelona, 170 Villaroel, E-30889 Barcelona, Spain
^c Department of Anesthesiology, Hannover Medical School, Hannover, Germany

Received 14 November 2005; received in revised form 29 December 2005; accepted 20 February 2006.

^_* Corresponding author. Address: Department of General Thoracic Surgery, Thoracic Clinical Institute, Hospital Clinic of Barcelona, University of Barcelona, 170 Villaroel, E-30889 Barcelona, Spain. Tel.: +34 93 2279959; fax: +34 93 2279813. (Email: pmacchiarini{at}clinic.ub.es).

Objective: To investigate whether deep (<20 °C) hypothermia is necessary in patients undergoing pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Methods: Between January 2004 and February 2005, 30 patients (New York Heart Association (NYHA) class III or IV) were randomly assigned to increasing (1 °C) levels of moderate (28–32°C) hypothermic cardiopulmonary bypass (CPB), each study group including six patients. Primary study endpoint was adverse neurological outcome. Overall preoperative total pulmonary vascular resistance was 1110 ± 192 dyne s cm^–5. Results: Mean CPB and cross-clamp times, and core temperature at the time of circulatory arrests were 129 ± 39 min and 92 ± 24 min, and 30.1 ± 1.5 °C, respectively. Circulatory arrest was induced 2 ± 0.7 times and its mean total duration was 10.3 ± 5.2 min (range, 2–19 min). Postoperatively, three patients (10%) belonging to the 31 °C (n = 1) and 32 °C (n = 2) groups suffered from temporary neurological dysfunction. Postoperative mechanical ventilatory support and ICU stay were 26.3 ± 18.9 h and 6.6 ± 8.5 days, respectively, and uninfluenced by degree of hypothermia. There were no lung reperfusion injuries or any other major complications. All patients had a significant hemodynamic improvement. Conclusion: Results suggest that pulmonary endarterectomy can be safely performed with moderate hypothermia and short periods of circulatory arrests without the need of profound hypothermia.

Key Words: Chronic pulmonary embolism • Pulmonary hypertension • Pulmonary endarterectomy • Moderate hypothermia

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