Pulmonary Embolectomy for Acute Pulmonary Embolism: A Word of Caution

Abstract Backgroud: Acute pulmonary embolism (PE) is one of the most critical cardiovascular disease. The treatment for PE depends on the severity of disease including anticoagulation, systemic thrombolysis, surgical embolectomy,and catheter embolectomy. The indication of surgical pulmonary embolectomy is still controvery. Although there have been more favourable reports of the of surgical embolectomy (SE) over past decades, SE has still been used as a resort or rescue treatment for acute massive PE with significant hemodynamically unstable or present with cardiogenic shock or patients whose thrombolysis failed，therefore the high mortality of pulmonary surgical embolectomy was still reported. SE has not yet been accepted broadly as initial therapy in the algorithm for massive and submassive PE.Objective : The purpose of this study is to evaluate the early and midterm outcome of surgical pulmonary embolectomy which was taken as the first line therapy for acute central major pulmonary embolism in one single center in ChinaMethods: A retrospective review of patients who underwent surgical pulmonary embolectomy for acute pulmonary embolectomy was conducted from July of 2005 to Sept of 2019 at a single heart center in China. Patients with chronic thrombus or thrombendrterectomy were excluded.The risk factors for morbidity and mortality of the surgical pulmonary embolectomy were reviewed, The institutional echocardiographic database was searched for follow-up studies to compare markers of right ventricular function.Results: A total of 41 patients were included for the study, 17 cases (41.5%) had submassive PE and 24 (58.5%) had massive pulmonary embolism required preoperative positive inotropic treatment. Mean cardiopulmonary bypass time was 103.2±48.9 minutes, and 10 patients (24.4.%) underwent procedures without aortic cross-clamping. Ventilatory support time was 80.6±21.3hours. ICU stay was 4.51±3.23 days. Hospital stay was 12.8±6.4days. There was operative mortality 3 (7.32%) for massive pulmonary embolism and no death case of submassive pulmonary embolism. For massive PE patients, if the first choice treatment was surgical embolectomy, the mortality was low,only 2.56%, even though there were 2 cases suffered from cardiac arrest preoperatively. However, if 2 cases who received systemic thromblysis firstly were included in the datus,the mortality rate of SE increased to 12.5%. All cases had echocardiography results available for follow-up at discharge,and 30 cases at three months, only 10 cases at one years after surgical embolectomy. There were no death event related with recurrent PE in the follow-up,but 3 patents died of cerebral incranal bleeding, gastric cancer and gastric cancer at 1 year,3 years and 8 years after surgical embolectomy respectively.Conclusions: In this small retrospective single center experience, SE presented with low mortality rate when it was rendered as the first line treatment in selected patients for massive and submassive acute pulmonary embolism. SE should play the the same role as ST in the treatment algorithm for acute PE. Echocardiographic showed right ventricular function was improved in the early and midterm follow- up term

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Surgical Techniques of Pulmonary Embolectomy for Acute Pulmonary Embolism

Operative Techniques in Thoracic and Cardiovascular Surgery ◽

10.1053/j.optechstcvs.2017.02.001 ◽

2016 ◽

Vol 21 (2) ◽

pp. 80-88 ◽

Cited By ~ 4

Author(s):

Pankaj Saxena ◽

Hassiba Smail ◽

David C. McGiffin

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Surgical Techniques ◽

Pulmonary Embolectomy

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Outcomes of Pulmonary Embolectomy for Acute Pulmonary Embolism

Circulation Journal ◽

10.1253/circj.cj-18-0371 ◽

2018 ◽

Vol 82 (8) ◽

pp. 2184-2190 ◽

Cited By ~ 6

Author(s):

Masahito Minakawa ◽

Ikuo Fukuda ◽

Hiroaki Miyata ◽

Noboru Motomura ◽

Shinichi Takamoto ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Pulmonary Embolectomy

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Emergent Surgical Pulmonary Embolectomy in a Pregnant Woman: Case Report and Literature Review

Texas Heart Institute Journal ◽

10.14503/thij-12-2692 ◽

2014 ◽

Vol 41 (2) ◽

pp. 188-194 ◽

Cited By ~ 7

Author(s):

Giovanni Saeed ◽

Michael Möller ◽

Jörg Neuzner ◽

Rainer Gradaus ◽

Werner Stein ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Pulmonary Arteries ◽

The United States ◽

Massive Pulmonary Embolism ◽

Healthy Male ◽

Pulmonary Embolectomy ◽

Mother And Child ◽

Pregnancy And Delivery ◽

Male Neonate

Acute pulmonary embolism is a leading cause of death during pregnancy and delivery in the United States. We describe the case of a 25-year-old woman who presented in car-diogenic shock in week 38 of her first pregnancy. After the emergent cesarean delivery of a healthy male neonate, the mother underwent immediate surgical pulmonary embolec-tomy. We confirmed the diagnosis of pulmonary embolism intraoperatively by means of transesophageal echocardiography and removed large clots from the patient's pulmonary arteries. Mother and child were doing well, 27 months later. In addition to presenting our patient's case, we discuss the other relevant reports and the options for treating massive pulmonary embolism during pregnancy.

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Short- and long-term outcomes for the surgical treatment of acute pulmonary embolism

Innovative Surgical Sciences ◽

10.1515/iss-2018-0024 ◽

2018 ◽

Vol 3 (4) ◽

pp. 271-276 ◽

Cited By ~ 1

Author(s):

Kathrin Dohle ◽

Daniel-Sebastian Dohle ◽

Hazem El Beyrouti ◽

Katja Buschmann ◽

Anna Lena Emrich ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Hospital Mortality ◽

Acute Pulmonary Embolism ◽

Pulmonary Embolectomy ◽

Vein Thrombosis ◽

Life Threatening ◽

Deep Vein

AbstractObjectivesAcute pulmonary embolism can be a life-threatening condition with a high mortality. The treatment choice is a matter of debate. The early and late outcomes of patients treated with surgical pulmonary embolectomy for acute pulmonary embolism in a single center were analyzed.MethodsAll consecutive patients operated on for pulmonary embolism between January 2002 and March 2017 were reviewed. Patient demographics and pre- and postoperative clinical data were retrieved from our patient registry, and risk factors for in-hospital and long-term mortality were identified.ResultsIn total, 175 patients (mean age 59±3 years, 50% male) were operated on for acute pulmonary embolism. In-hospital mortality was 19% (34/175). No differences were found when comparing surgery utilizing a beating heart or cardioplegic arrest. Risk factors for in-hospital mortality were age >70 years [odds ratio (OR) 4.8, confidence interval (CI) 1.7–13.1, p=0.002], body surface area <2 m2 (OR 4.7, CI 1.6–13.7, p=0.004), preoperative resuscitation (OR 14.1, CI 4.9–40.8, p<0.001), and the absence of deep vein thrombosis (OR 9.6, CI 2.5–37.6, p<0.001). Follow-up was 100% complete with a 10-year survival rate of 66.4% in 141/175 patients surviving to discharge. Once discharged from hospital, none of the risk factors identified for in-hospital mortality were relevant for long-term survival except the absence of deep vein thrombosis (OR 3.2, CI 1.2–8.2, p=0.019). The presence of malignancy was a relevant risk factor for long-term mortality (OR 4.3, CI 1.8–10.3, p=0.001).ConclusionSurgical pulmonary embolectomy as a therapy for acute pulmonary embolism demonstrates excellent short- and long-term results in patients with an otherwise life-threatening disease, especially in younger patients with a body surface area >2 m2 and pulmonary embolism caused by deep vein thrombosis. Pulmonary embolectomy should therefore not be reserved as a treatment of last resort for clinically desperate circumstances.

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