Outcomes after surgical pulmonary embolectomy for acute submassive and massive pulmonary embolism: A single-center experience

Abstract

In this single institution experience, surgical pulmonary embolectomy is a safe and effective therapy to treat patients with a submassive or massive pulmonary embolism. Although survival in this study is higher than previously reported for patients treated with medical therapy alone, a prospective trial comparing surgical therapy with medical therapy is necessary to further elucidate the role of surgical pulmonary embolectomy in the treatment of pulmonary embolism.

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

“…Surgical embolectomy in acute PE is usually carried out with cardiopulmonary bypass, without aortic cross-clamping and cardioplegic cardiac arrest, followed by incision of the two main pulmonary arteries with the removal or suction of fresh clots. Recent reports have indicated favourable surgical results in high-risk PE, with or without cardiac arrest, and in selected cases of intermediate-risk PE [297][298][299][300]. Among 174 322 patients hospitalized between 1999 and 2013 with a diagnosis of PE in New York state, survival and recurrence rates were compared between patients who underwent thrombolysis (n=1854) or surgical embolectomy (n=257) as first-line therapy [297].…”

“…Recent experience appears to support combining ECMO with surgical embolectomy, particularly in patients with high-risk PE with or without the need for cardiopulmonary resuscitation. Among patients who presented with intermediate-risk PE (n=28), high-risk PE without cardiac arrest (n=18), and PE with cardiac arrest (n=9), the in-hospital and 1 year survival rates were 93 and 91%, respectively [300].…”

Peripheral Distribution of Thrombus Does Not Affect Outcomes After Surgical Pulmonary Embolectomy

“…As previously described, patients referred for a surgical pulmonary embolectomy were offered surgical intervention if their predicted risk of 30-day mortality was 5% or higher [15]; therefore, all patients included in this study had a predicted risk of death of 5% or more. Risk of death for submassive PE patients was based on the Bova score, an internally and externally validated risk model specifically for submassive PE patients [16,17].…”

“…Operative technique was performed as previously described [15]. Briefly, a median sternotomy was performed, and cardiopulmonary bypass was initiated by bicaval venous and central aortic cannulation.…”

Low Level of Antithrombin Iii as a Warning Sign for Developing Thrombotic Complications in Surgical Patients

“…A statistical series of population-based studies was used to determine the main reasons and risk factors for pulmonary embolism [2][3][4][5][6], and to develop clinical practice guidelines to prevent thromboembolic complications. However, despite the efficiency of the approach for preventing thromboembolic complications being demonstrated, a third of patients show a high probability of thromboembolic disorders [7]. In this regard, the main purpose of our work is to find a warning for PE development in non-cardiosurgical patients that have undergone intensive therapy under conditions of general surgical ICU, among the indicators of haemostasis system.…”