Pulmonary endarterectomy surgery for chronic thromboembolic pulmonary hypertension: A small-volume national referral center experience

Michael J. Segel*, Alexander Kogan, Sergey Preissman, Nancy Agmon-Levin, Aaron Lubetsky, Paul Fefer, Hans Joachim Schaefers, Ehud Raanani

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease, which is caused by chronic obstruction of major pulmonary arteries. CTEPH can be cured by pulmonary endarterectomy (PEA). PEA for CTEPH is a challenging procedure, and patient selection and the perioperative management are complex, requiring significant experience. Objectives: To describe the establishment of a national CTEPH-PEA center in Israel and present results of surgery. Methods: In this study, we reviewed the outcomes of PEA in a national referral, multi-disciplinary center for CTEPH-PEA. The center was established by collaborating with a high-volume center in Europe. A multidisciplinary team from our hospital (pulmonary hypertension specialist, cardiac surgeon, cardiac anesthesiologist and cardiac surgery intensivist) was trained under the guidance of an experienced team from the European center. Results: A total of 38 PEA procedures were performed between 2008 and 2018. We included 28 cases in this analysis for which long-term follow-up data were available. There were two hospital deaths (7%). At follow-up, median New York Heart Association (NYHA) class improved from III to I (P < 0.0001), median systolic pulmonary pressure decreased from 64 mmHg to 26 mmHg (P < 0.0001), and significant improvements were seen in right ventricular function and exercise capacity. Conclusions: A national center for performance of a rare and complex surgical procedure can be successfully established by collaboration with a high-volume center and by training a dedicated multidisciplinary team.

Original languageEnglish
Pages (from-to)528-531
Number of pages4
JournalIsrael Medical Association Journal
Issue number8
StatePublished - 2019


  • Chronic thromboembolic pulmonary hypertension (CTEPH)
  • Pulmonary endarterectomy (PEA)
  • Pulmonary vascular disease


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