Chronic thromboembolic pulmonary hypertension at the crossroad.

Chronic thromboembolic pulmonary hypertension (CTPEH) is one of the few forms of pulmonary hypertension for which we have a clear and undisputed solution, i.e. pulmonary endarterectomy (PEA). In the vast majority of patients, PEA markedly improves or even cures the disease [1]. Over the years, surgeons have continuously improved their skills and are now reaching beyond the level of the subsegmental vessels. Patients, who would have been considered inoperable a couple of years ago, are now undergoing surgery and are surviving and doing well! In San Diego (CA, USA), considered the epicentre of the PEA universe, the in-hospital mortality for the most recent 500 surgeries in this field was 2.2% with no mortalities among the last 260 procedures; despite the patients presenting with more peripheral disease and more co-morbidities [2]. Recent reports from other centres are comparable [3, 4].