Age should not be a barrier for pulmonary endarterectomy in carefully selected patients

Pulmonary endarterectomy (PEA) is the treatment of choice in operable chronic thromboembolic pulmonary hypertension (CTEPH) with excellent long-term outcomes [1]. It is a complex surgical procedure requiring cardiopulmonary bypass and removal of obstructive thromboembolic material during periods of deep hypothermic circulatory arrest [1]. We have observed an increase in the number of older CTEPH patients referred for consideration of PEA, which is consistent with other cardiothoracic surgeries. The UK population is ageing with a projected 3% increase in subjects aged >85 years in the next 20 years [2]. This may be mirrored by patients with CTEPH getting older, as the incidence of pulmonary embolism, which frequently precedes CTEPH, markedly increases with age [3, 4]. Furthermore, an epidemiological analysis by Gall et al. [5] has projected that the annual incidence of CTEPH will increase over the next 10 years. Therefore, the management of CTEPH in older patients is a pertinent topic for investigation.