Pulmonary thromboendarterectomy (PTE)

Pulmonary thromboendarterectomy (PTE) is a surgery used to remove blood clots and scar tissue from the lung’s arteries. Caused by a rare pulmonary disease called chronic thromboembolic pulmonary hypertension (CTEPH), these persistent blood clots and scar tissue can block or narrow the lung’s arteries and elevate blood pressure in the lungs. This makes it harder for the heart to pump blood to the lungs and can be life threatening if not treated. PTE can cure CTEPH.

Penn Medicine is one of a handful of hospitals in the nation that offer this procedure to remove blood clots from the lungs. Our targeted pulmonary vascular disease program includes highly skilled experts with experience in complex pulmonary embolism surgery, like PTE. A collaborative team of specialists includes cardiac surgeons, thoracic surgeons, interventional cardiologists, lung pathologists, pulmonologists, and rehabilitation providers who work together to provide complete care and ongoing support from surgery through recovery.

If you have a history of blood clots in the lungs (pulmonary embolisms) that are chronic and unresponsive to medication and you have been diagnosed with CTEPH, you may be eligible for this lung clot surgery. Your doctor will review your medical history and evaluate the severity of your symptoms, which may include chest pain, dizziness, shortness of breath, and fatigue. They’ll also identify the characteristics and position of your blockages to be sure they can be accessed through PTE surgery.

In some cases, you may not be eligible for a pulmonary thromboendarterectomy. Your doctor will consider your age and overall health to determine whether you are a good candidate to undergo surgery and fully recover. If you cannot proceed with PTE surgery, they’ll recommend other treatment options, such as balloon pulmonary angioplasty (BPA).

PTE surgery is a major operation that can last six hours or longer. Talk with your doctor about what to expect before, during, and after the procedure, so you can take steps to support your health and well-being, starting from preparing for surgery through recovery. You’ll receive pre-surgical guidelines that include when to fast, what medicines to avoid, and instructions on substances to avoid like tobacco and alcohol.

On the day of the procedure, you can expect these steps:

• You’ll be given anesthesia through an IV (intravenous line) to put you to sleep and keep you comfortable during surgery.
• An incision is made in your breastbone (sternum), where the surgeon will use specialized tools to remove blood clots from your lung’s arteries along with surrounding scar tissue.
• Machines will be used to support essential body functions while the doctor works on your lungs. You’ll be connected to an oxygen machine (ventilator) to manage your breathing and to a cardiopulmonary bypass machine to take over your heart and lung functions when needed.
• Your body will be cooled to around 65 degrees Fahrenheit at certain points during the operation and then returned to a normal body temperature. The cooler temperature helps protect organs and gives your surgeon better visibility into the surgical site by stopping blood flow in the impacted area while machines take over critical body functions.
• After the blood clots and scar tissue are removed, you’ll be disconnected from the bypass machine, and the incision in your chest will be closed. Some tubes may remain to drain liquid from your chest for a few days.
• You’ll stay connected to the ventilator for a while after surgery until your care team observes that you can breathe on your own, often the following day or two.

You’ll be moved to an intensive care unit (ICU) immediately after surgery and monitored carefully before moving to another hospital room where you’ll stay for a week or more before you go home.

A pulmonary thromboendarterectomy is major open-heart surgery, and your full recovery will take some time. You may notice your breathing is improved even in the first days or weeks after surgery. Your breathing will continue to improve over time.

While in the hospital, you’ll start taking small walks and begin working with rehabilitation specialists to regain your overall strength. You’ll take blood thinning medications (anticoagulants) immediately to reduce the likelihood of developing more blood clots, and you’ll stay on these medications for life. You’ll have some tests to assess your post-surgery health, which will help determine if you need additional support at home, like an oxygen machine or medications to control any lingering pulmonary hypertension.

Once you return home, you’ll have some restrictions on certain activities for a while. You may not be able to drive for a few weeks, and you won’t be able to lift more than 10 pounds for a month or longer. You’ll continue to regain strength gradually and should be able to fully return to your normal daily activities after about three months. Your care team will provide you with a list of lifestyle guidelines and connect you with a rehabilitation team to set up a schedule of appointments. It’s important to follow your pulmonary rehabilitation program and attend all follow-up appointments with your doctors to ensure that you stay on track for the best recovery.

PTE surgery is a successful treatment for CTEPH, though like any major surgery there are some risks. Your doctor will answer any questions you have about possible risks, which may include:

• Unusual bleeding
• Infection
• Chest pain
• Fainting
• Sudden issues with breathing
• Irregular heartbeat (arrhythmia)
• Fluid buildup around the heart or in the lungs
• Unresolved pulmonary hypertension
• Pneumonia

Contact your care team if you experience any of these issues, and they’ll recommend additional treatment to support your recovery.

Penn Medicine is home to specialized diagnostic and treatment programs for people with acute and chronic pulmonary vascular diseases. Our doctors are internationally recognized for their expertise and surgical experience, providing highly skilled care close to home for those in the southeastern Pennsylvania and New Jersey regions.

As a leader in clinical research for pulmonary medicine, we have access to advanced therapies and innovative technologies to treat even the rarest conditions like CTEPH. Our goal is to create tailored treatment plans using the latest techniques to help you stay healthy and get back to living your life fully.