Acute Pulmonary Thromboembolism: 14 Years of Surgical Experience

Park, Jiye; Lim, Sang-Hyun; Hong, You Sun; Park, Soo‐Jin; Lee, Cheol Joo; Lee, Seung Ook

doi:10.5090/kjtcs.2019.52.2.78

Cited by 9 publications

(14 citation statements)

References 12 publications

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“…These include novel techniques such as right thoracotomy and several iterations of ministernotomy approaches with and without the use of cardiopulmonary bypass. 2,7 -9…”

Section: Discussionmentioning

confidence: 99%

“…As such, surgical embolectomy has classically been associated with poor outcomes and increased rates of patient morbidity and mortality. 2,6 These outcomes can largely be attributed to the strict criteria used to determine which patients are eligible for surgical intervention, leaving only the highest-risk patients operated upon. However, newer, innovative surgical techniques have illustrated that surgical pulmonary embolectomy can be performed successfully, and less invasively, in patients with massive PE who do not present in extremis.…”

Section: Introductionmentioning

confidence: 99%

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Initial Experience with Non-Sternotomy Minimally Invasive Pulmonary Embolectomy with Thoracoscopic Assistance

Greenberg

Gupta

Lattouf

2020

Innovations�(Phila)

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The endpoint in emergent management of acute massive pulmonary embolism (PE) has traditionally been with embolectomy through standard median sternotomy. This approach is limited in both exposure and concomitant functional morbidity associated with sternotomy. Herein we describe a novel minimally invasive, thoracoscopically assisted approach to pulmonary embolectomy. This utilizes a small 5-cm left parasternal thoracotomy and femoral cardiopulmonary bypass to conduct thoracoscopically assisted surgical pulmonary embolectomy. This novel minimally invasive approach has been developed and successfully utilized in 3 patients with massive PE at our institution. The assistance of the thoracoscope allowed for complete visualization and clot extraction of the main and segmental pulmonary arteries bilaterally. The use of a non-sternotomy approach sped both functional and pulmonary recovery times and decreased length of stay. These initial data suggest that non-sternotomy minimally invasive surgical pulmonary embolectomy with thoracoscopic assistance is a feasible and safe approach for acute massive PE that may result in enhanced recovery times and decreased hospital length of stay.

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“…These include novel techniques such as right thoracotomy and several iterations of ministernotomy approaches with and without the use of cardiopulmonary bypass. 2,7 -9…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Initial Experience with Non-Sternotomy Minimally Invasive Pulmonary Embolectomy with Thoracoscopic Assistance

Greenberg

Gupta

Lattouf

2020

Innovations�(Phila)

View full text Add to dashboard Cite

show abstract

“…However, there is still controversy regarding SPE outcomes. Park [16] reported a 14.8% surgical treatment mortality rate. Reza [6] recently reported 36 massive PE surgical treatments with 10 deaths and a mortality rate of 27.8%.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism: a single-centre study in China

Wang

Chen

Qiu

et al. 2020

J Cardiothorac Surg

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Background Acute pulmonary embolism (PE) is one of the most critical cardiovascular diseases. PE treatment ranges from anticoagulation, and systemic thrombolysis to surgical embolectomy and catheter embolectomy. Surgical pulmonary embolectmy (SPE) indications and outcomes are still controversial. Although there have been more favourable SPE reports over the past decades, SPE has not yet been considered broadly as an initial PE therapy and is still considered as a reserve or rescue treatment for acute massive PE when systemic thrombolysis fails. This study aimed to evaluate the early and midterm outcomes of SPE, which was a first-line therapy for acute central major PE in one Chinese single centre. Methods A retrospective review of patients who underwent SPE for acute PE was conducted.Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular function. Results Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2 ± 48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping. Ventilatory support time was 78 h (range, 40–336 h), intensive care unit stay was 7 days (range, 3–13 days), and hospital stay was 16 days (range, 12–23 days). Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients’ right ventricle function improved postoperatively in follow-ups.There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively. Conclusions SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups. SPE should play the same role as ST in algorithmic acute PE treatment.

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“…However, there is still controversy regarding SPE outcomes. Park 16 reported a 14.8% surgical treatment mortality rate. Reza 6 recently reported 36 massive PE surgical treatments with 10 deaths and a mortality rate of 27.8%.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism：a single-centre study in China

Wang

Chen

Qiu

et al. 2020

Preprint

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Background: Acute pulmonary embolism (PE) is one of the most critical cardiovascular diseases. PE treatment ranges from anticoagulation, and systemic thrombolysis to surgical embolectomy and catheter embolectomy. Surgical pulmonary embolectmy (SPE) indications and outcomes are still controversial. Although there have been more favourable SPE reports over the past decades, SPE has not yet been considered broadly as an initial PE therapy and is still considered as a reserve or rescue treatment for acute massive PE when systemic thrombolysis fails. This study aimed to evaluate the early and midterm outcomes of SPE, which was a first-line therapy for acute central major PE in one Chinese single centre. Methods: A retrospective review of patients who underwent SPE for acute PE was conducted .Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular functionResults: Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2±48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping . Ventilatory support time was 78 h (range, 40-336 h), intensive care unit stay was 7 days (range, 3-13 days), and hospital stay was 16 days (range, 12-23 days).Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients’ right ventricle function improved postoperatively in follow-ups .There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively. Conclusions: SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups . SPE should play the same role as ST in algorithmic acute PE treatment.

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Acute Pulmonary Thromboembolism: 14 Years of Surgical Experience

Cited by 9 publications

References 12 publications

Initial Experience with Non-Sternotomy Minimally Invasive Pulmonary Embolectomy with Thoracoscopic Assistance

Initial Experience with Non-Sternotomy Minimally Invasive Pulmonary Embolectomy with Thoracoscopic Assistance

Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism: a single-centre study in China

Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism：a single-centre study in China

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