Early and Late Clinical Outcomes of Pulmonary Embolectomy for Acute Massive Pulmonary Embolism

Vohra, Hunaid A.; Whistance, Robert N.; Mattam, Kavitha; Kaarne, Marrkku; Haw, Marcus P.; Barlow, Clifford W.; Tsang, Geoffrey; Livesey, Steven; Ohri, Sunil K.

doi:10.1016/j.athoracsur.2010.08.002

Cited by 49 publications

(29 citation statements)

References 26 publications

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“…Three main strategies were considered to treat this patient: surgical thrombectomy,7 8 systemic thrombolysis and catheter direct interventions,9 10 and lastly anticoagulation 11. Surgery with reversal of anticoagulation may lead to further coagulation, if previously anticoagulated with elevated risk of bleeding complications, transient ischaemic attacks and cardiac tamponade 12. The significant pulmonary hypertension and RV dysfunction raised the prospect that the patient might not tolerate weaning from cardiopulmonary bypass following thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria

Zafar¹,

Anderson

Cox

et al. 2018

BMJ Case Reports

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A 59-year-old woman presented with a sudden onset of breathlessness and chest pain. An echocardiography and CT scan showed pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria. For haemodynamically stable patients, the optimal management strategy is poorly defined. Three main strategies were considered: surgical thrombectomy, thrombolysis and anticoagulation. Surgery with reversal of anticoagulation may lead to further coagulation and increased risk of bleeding complications. The significant pulmonary hypertension and right ventricular infarction raised the prospect of difficult weaning from cardiopulmonary bypass following thrombectomy. Thrombolysis, which has significant mortality rate, and systemic embolisation including pulmonary infarction with haemorrhagic transformation were also contraindications. A multidisciplinary approach was adopted and anticoagulation was therefore believed to be the safest and effective approach. Here, the use of anticoagulation alone was fortunately successful but could as easily end in disaster. This approach should be considered the ideal paradigm to yield optimum outcomes.

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Section: Discussionmentioning

confidence: 99%

Pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria

Zafar¹,

Anderson

Cox

et al. 2018

BMJ Case Reports

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“…In a small series by Digonnet et al, surgical embolectomy in hemodynamically stable patients with RV dysfunction demonstrated excellent surgical outcomes and longterm survival [120]. Although there is lack of a definitive study, there is increasing evidence to suggest favorable outcomes of an early approach to surgical embolectomy in critically ill patients with massive PE [121][122][123][124][125][126][127][128][129].…”

Section: Surgical Embolectomy and Catheter-directed Therapiesmentioning

confidence: 97%

Care of patients with acute pulmonary emboli: a clinical review with cardiovascular focus

Smith

Morgenthaler

Mankad

2012

Expert Review of Cardiovascular Therapy

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Acute pulmonary embolism (PE) is a common, multidisciplinary disease with substantial associated morbidity, mortality and healthcare expense. In this article we present a succinct review of diagnostic tools, risk stratification and medical therapies for cardiovascular care of patients with acute PE. While pulmonary angiography remains the 'gold standard' for diagnosis, a host of diagnostic modalities, interpreted in the setting of clinical probability, are available for patient assessment, including ECG, chest radiography, D-dimer, lower-extremity venous ultrasound, ventilation-perfusion scans, computed tomography and magnetic resonance angiography, and echocardiography, each with associated value. Diagnostic algorithms incorporate multiple tools in order to obtain a more comprehensive evaluation. Therapeutic anticoagulation remains the mainstay of therapy in PE. In massive PE, utilization of thrombolysis is reasonable in the absence of contraindications. Submassive PE, characterized by right ventricular dysfunction as assessed by echocardiography and ECG, is associated with higher mortality. Use of thrombolysis in submassive PE remains controversial. Catheter-directed therapies are emerging as an added approach to acute PE and have the potential to improve outcomes in PE. Use of inferior vena cava filters should be pursued in a select patient population as they serve to reduce recurrent acute PE; however, they are associated with more frequent deep venous thrombosis and provide no mortality benefit. In risk-stratified hemodynamically stable patients, an outpatient management strategy inclusive of therapeutic anticoagulation and careful clinical follow-up may be appropriate.

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“…who are hemodynamically stable but show signs of right ventricular dysfunction on echocardiography or CT) have documented mortality rates of 6-8% [1,4]. However, several other case series demonstrate much higher mortality rates, with the majority of deaths occurring in patients who require preoperative cardiopulmonary resuscitation [5,13] as well as in those undergoing delayed pulmonary embolectomy [6] or prior failed thrombolysis [3]. In our series, all patients undergoing echocardiography had findings of right ventricular failure, indicating a high risk for subsequent deterioration.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolectomy in the Treatment of Submassive and Massive Pulmonary Embolism

Worku¹,

Gulkarov²,

Girardi³

et al. 2014

Cardiology

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Objectives: Significant improvements in outcomes after pulmonary embolectomy have resulted in a broadening of indications. We reviewed our experience with pulmonary embolectomy over the past 12 years with an emphasis on preoperative comorbidities and postoperative morbidity and mortality. Methods: All patients undergoing pulmonary embolectomy over the past 12 years at our institution were analyzed via retrospective chart review. Data on preoperative characteristics, operative procedures and postoperative outcomes were collected. Results: Twenty patients underwent pulmonary embolectomy between 1999 and 2011. The average age was 56 years (range 24-81) and 10 patients (50%) were female. All patients demonstrated right ventricular dysfunction and 19 (95%) demonstrated contraindications to thrombolysis. Twelve patients (60%) demonstrated intermittent hypotension, 4 (20%) required intubation and 3 (15%) demonstrated preoperative or intraoperative cardiac arrest. Survival to discharge was 95%. Conclusions: Pulmonary embolectomy has been shown to be safe and effective in the treatment of massive pulmonary embolism (PE). We achieved a 95% survival rate in a cohort of patients with significant comorbid status. Pulmonary embolectomy should be considered early in the therapeutic algorithm for patients with submassive PE presenting with right ventricular dysfunction to prevent progression. It can also be performed with good outcomes in those already suffering hemodynamic compromise.

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Early and Late Clinical Outcomes of Pulmonary Embolectomy for Acute Massive Pulmonary Embolism

Cited by 49 publications

References 26 publications

Pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria

Pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria

Care of patients with acute pulmonary emboli: a clinical review with cardiovascular focus

Pulmonary Embolectomy in the Treatment of Submassive and Massive Pulmonary Embolism

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