Pulmonary endarterectomy and the cost of patient refusal

Without effective treatment, patients with chronic thromboembolic pulmonary hypertension (CTEPH) will struggle and ultimately die of right heart failure [1]. The key pathological features of CTEPH consist of obstructive chronic thrombi (resistant to thrombolysis and despite adherence to anticoagulation) in the proximal elastic pulmonary arteries combined with varying degrees of microvascular remodelling [2, 3]. Both processes contribute to pulmonary hypertension, but the successful removal of the proximal mechanical component with pulmonary endarterectomy (PEA) often leads to dramatic improvement in pulmonary hypertension with improved quality of life and better long-term survival [4–6]. Accordingly, the treatment of choice for patients suffering from CTEPH remains PEA to remove all accessible obstructive disease within the pulmonary arteries thereby improving pulmonary circulation [5, 7]. The report by Quadery et al. [8] in this issue of the European Respiratory Journal is a timely reminder regarding the importance and benefits of PEA, and the risk patients take when an offer of PEA is refused.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Editorials Source Type: research