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Miracle surgical technique: Why cooling the whole body to 20 degrees makes heart surgery safer?
In thoracic surgery, pulmonary thromboendarterectomy (PTE) is a specialized procedure designed to remove an organized clot (thrombus) in the pulmonary arteries that supply blood to the lungs. This procedure is particularly suitable for patients with underlying pulmonary embolism who are candidates for surgery, as these clots often lead to chronic thrombotic pulmonary hypertension (CTEPH). Currently, PTE is the only definitive option for treating CTEPH.
The risks of surgery are significant, and the mortality rate for PTE is typically 5%. However, in experienced, high-volume centers, this number is even lower.
PTE involves comprehensive cardiopulmonary bypass (CPB), profound hypothermia, and cardiac arrest. The high-risk nature of these procedures means that surgery may not be feasible in some patients, particularly those with significant hemodynamic or ventilatory impairment.
Description of surgery
During surgery, CPB is inserted to allow blood to temporarily bypass the heart and lungs and supply the oxygen needed by the whole body. Cardiac pauses are used because the movement of the heart complicates delicate manipulation of the pulmonary artery. It is worth noting that hypothermia is essential to maintain this behavior, since without cooling the patient to 18 to 20 degrees, the metabolism cannot be lowered, allowing the body to better tolerate the lack of blood supply.
During the operation, blood flow will be completely stopped for 20 minutes to protect the patient's brain function.
An experienced surgeon can usually perform an entire unilateral procedure within this time. After the operation, most patients no longer have difficulty breathing, their quality of life improves significantly, and pulmonary vascular resistance usually returns to normal levels, thereby reducing the burden on the heart.
Recovery and Complications
However, recovery is not always smooth sailing. Patients may face several complications due to hypothermia, cardiac arrest, and CPB-related procedures. Including reperfusion pulmonary edema and pulmonary artery steal phenomena, reperfusion pulmonary edema occurs in 30% of patients, which requires effective ventilation and fluid management.
The incidence of pulmonary artery steal phenomenon reaches 70%. This is a change in blood flow, and most of the symptoms are self-limiting.
Although PTE surgery has potential risks, its benefits are significant and can effectively improve the patient's quality of life.
History and Development
According to 2008 data, the Department of Cardiothoracic Surgery at the University of California, San Diego was considered a pioneer in this emerging surgery and has completed more than 3,000 PTE surgeries. Pulmonary endarterectomy in the UK is mainly concentrated at the Royal Pabos Hospital, where it is performed by several professional doctors, with about 190 operations performed every year.
Association with pulmonary thrombectomy
PTE and pulmonary thrombectomy both aim to remove clots in the pulmonary arteries, but they differ in tactics and urgency. PTE is generally performed in non-emergency settings and is often combined with deep cooling, whereas clean pulmonary thrombectomy is performed in acute settings and does not require hypothermia. It can be seen that this is not only a breakthrough in medical technology, but also an evolution in lung surgical management.
The complexity and advantages of surgery guide future research directions. What we must think about is, as surgical technology advances, can we explore a wider range of alternatives to these high-risk surgeries to reduce the associated complications and risks?
