PTE is a very delicate 8-hour surgical procedure performed under general anesthesia. First the chest is opened and the patient is attached to a heart-lung bypass machine, and then the patient’s body is cooled to about 68 degrees Fahrenheit, which reduces the body’s need for oxygen. The surgeons then open the arteries blocked by the clots, after which the heart-lung machine is turned off to create a bloodless surgical field.
While there is no blood flow, surgeons carefully extract the clots from the pulmonary artery walls. This on-off process with the heart-lung bypass machine is repeated until all of the clots are extracted. The arteries are sewn closed, blood is again allowed to flow through them, and, finally, the chest is sewn closed.
“You open the main branches and you work through these things like keyholes, working down through the channels so you are progressively going through smaller and smaller holes in the lung without going into the chest,” explains Dr. Bartley Griffith, UMMC's chief of cardiac surgery. “To do it, there are specialized instruments -- magnifying glasses -- that help us basically carve out the 'onion skins' from the inside. There are outer layers and you have to get out in order to adjust the artery wall itself.”
How long does it take to recover? When can normal activities be resumed?
Typically, it takes patients about four weeks to fully recover from the surgery. “Patients get back on their feet quickly. Within a four-week period they go from coming in my office in a wheelchair to walking out of the office,” Dr. Griffith said.
What is the difference in quality of life after surgery?
PTE surgery restores and improves lung function and capacity. After surgery, patients can breathe much better because it cures the heart failure, which is what caused their shortness of breath. After the surgery, these symptoms disappear.
“PTE offers a cure, versus changing the disease (as in the case with a lung transplant). After surgery, patients usually only require a blood thinner/anticoagulant, and patients are also periodically followed with CT scans,” Dr. Griffith said.