Pulmonary Endarterectomy (PEA)
Perfusion Management – Technical Notes
Core Perfusion Strategy
•Full CPB with bicaval cannulation
•Target DHCA at 18–20°C
•Ensure excellent venous drainage
•Maintain uniform cooling (ΔT <10°C)
⸻
Cooling Phase
•Duration: 30–45 min
•Strategy: Alpha-stat
•Monitor:
•NIRS (cerebral saturation)
•Core vs peripheral temp gradient
⸻
Circulatory Arrest (DHCA)
•Max 20 min per cycle
•Mandatory reperfusion between cycles
•Perfusionist role:
•⏱️ Strict time tracking
•📢 Continuous communication
•🧠 Brain protection priority
⸻
Reperfusion & Rewarming
•Gradual rewarming (≤0.5°C/min)
•Avoid cerebral hyperthermia
•Lung protection:
•Low FiO₂ initially
•Controlled pulmonary flow
⸻
Critical Pitfalls
•Inadequate drainage → poor exposure
•Overheating during rewarming
•Prolonged DHCA → neurologic risk
•Reperfusion lung injury
⸻
Key Pearls
•“Time discipline = brain protection”
•Smooth cooling/rewarming is as important as arrest
•Anticipate coagulopathy early
⸻
Take-Home Message
Safe PEA depends on precise coordination between surgeon & perfusionist, with strict control of DHCA timing, temperature, and reperfusion.
Dr.Sam Zeraatian Nejad Davani, Cardiovascular and Transplant surgeon. Advanced Fellow of Thoracic Organs Transplantation Chicago Illinois.