Expanding the boundaries of PTE: successful integration with multiple major cardiac procedures.

Pulmonary thromboendarterectomy (PTE) is the only curative treatment for chronic thromboembolic pulmonary hypertension. While combining PTE with a single cardiac procedure is well established, evidence for performing it with multiple major procedures is limited. We report a successful bilateral PTE with coronary artery bypass grafting, ascending aortic and hemiarch repair, patent foramen ovale closure, and left atrial appendage ligation. The patient recovered uneventfully, with marked functional and hemodynamic improvement at 6 months. This case demonstrates the safety and feasibility of complex cardiac surgery with PTE, underscoring the value of thorough, multidisciplinary preoperative planning.