Pulmonary Embolectomy for Acute Massive Pulmonary Embolism

Abstract

During the period from 1961 to 1981, 40 pulmonary embolectomies were performed in 39 patients who were in extremis at the time of initiation of cardiopulmonary bypass. In a 460-bed hospital with more than 17,000 acute admissions and 4,000 operations per year, this small number represents the few patients who are potentially salvageable by urgent embolectomy. Preoperative angiography was performed in 57% of the cases, and in another ten patients suspected of having pulmonary emboli, angiography prevented unnecessary thoracotomy. Despite their moribund condition, 43% of the embolectomy patients lived. Excluding two patients with tumor occlusion of the pulmonary arteries and three patients with chronic cor pulmonale from old pulmonary emboli, the survival rate was 50%. Ten patients died because of hypoxemia and hypotension prior to initiation of cardiopulmonary bypass, and seven died of myocardial depression of multiple etiologies. Portable cardiopulmonary bypass affords the possibility of survival in moribund patients with acute massive pulmonary embolism. Preoperative angiography is recommended to guide appropriate surgical management.

Protection of the Right Ventricular Myocardium during Acute Right Heart Failure from Pulmonary Hypertension

“…Using this approach, a faster and definite treatment of the disorder can be of fered when compared to medical treatment, especially, if continuous closed chest massage has become necessary. Even under these ad verse conditions, patients can be salvaged by surgical intervention, as shown in our own experience and that of others [7,8],…”

The Surgical Option in the Management of Acute Pulmonary Embolism

“…Survival after surgical embolectomy has improved over the years. The articles published before the early 90s reported mortality in patients undergoing surgical pulmonary embolectomy for an acute massive PE raging from 30 to 55% 21‐24 . In the papers published since 2000, the mortality has decreased, ranging in this current era from 6 to 27% 25‐27 …”

Perioperative pulmonary embolism: diagnosis and anesthetic management

“…The indication for surgical embolectomy remains limited to patients with hemodynamic compromise who have failed thrombolysis or have contraindications to thrombolysis [81]. Since 2000, the mortality associated with pulmonary embolectomy has been cited as 6% to 27% [95][96][97][98], representing a significant decline from earlier reports of 30% to 55% mortality [99][100][101][102].…”