Surgical Therapy of Fulminant Pulmonary Embolism: Early and Late Results

Doerge, Hilmar; Schoendube, Friedrich A.; M, Voss; Seipelt, R; Messmer, B. J.

doi:10.1055/s-2007-1013100

Cited by 53 publications

(18 citation statements)

References 16 publications

(27 reference statements)

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“…[2,3] On the other hand, with rapid diagnosis, careful patient selection, and improved surgical techniques, high survival rates of 89% at 10 months have been achieved. [24] Debates continue regarding whether or not the complexity of the surgical procedure is worth the risk and whether there are enough postoperative care facilities that have sufficient experience to care for patients who undergo this procedure.…”

Section: Discussionmentioning

confidence: 99%

“…[1] The operative mortality rate for a surgical embolectomy is stated to be 20-50% because it is usually performed on moribund patients and is often followed by prolonged resuscitation. [2,3] Because of this, a surgical embolectomy is seldom performed today, even though it is a viable option for the management of these patients. On the other hand, a surgical embolectomy performed in cases of APE has also been stated to reduce the progression to chronic thromboembolic pulmonary hypertension (CTPHT).…”

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confidence: 99%

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Pulmonary embolectomy and thromboendarterectomy in seven cases

Hazan¹,

Şişli²,

Uğurlu³

et al. 2012

Turk Gogus Kalp Dama

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Amaç: Bu çalışmanın amacı, akut pulmoner emboli (APE) ve kronik tromboembolik pulmoner hipertansiyon (KTPHT) olgularının cerrahi ile belirgin olarak düzeldiklerini öngören kanıta dayalı veriler temelinde cerrahi sonrası seyir ile ilgili belirsizliği azaltmak ve bu olgularda cerrahi tedavi seçeneklerini dikkate alan doktorları cesaretlendirmektir. Ça lış ma pla nı: Bu gözlemsel ve geriye dönük gerçekleştirilen çalışmaya Şubat 2009 ile Ekim 2010 tarihleri arasında, APE ve KTPHT tanısı ile ameliyat edilen yedi olgu (3 erkek, 4 kadın; ort yaş 43.8±18.5 yıl; dağılım 25-73 yıl) dahil edildi. Hastaların ameliyat öncesi ve sonrası ortalama pulmoner arter basıncı (mPAP), New York Heart Association (NYHA) fonksiyonel sınıfı, yoğun bakım ünitesi (YBÜ) ve hastanede kalış süresi, demografik, klinik ve ameliyat özellikleri kaydedildi. Olgu sayısının yetersizliğinden dolayı istatistiksel analizler, parametrik olmayan testler ile yapıldı. Grupların karşılaştırılmasında Wilcoxon testi kullanıldı. Bul gu lar: Cerrahi sonrasında bütün hastalarda mPAP'da 20 mmHg (dağılım 5-53) düşüş sağlandı ve altıncı olgu hariç tüm olguların mPAP'ları, 30 mmHg'nın altına çekildi. Ameliyat öncesi ve sonrası mPAP'ları, sırasıyla 43 mmHg (dağılım 33-68) ve 23 mmHg (dağı-lım 15-37) idi. Bu durumda cerrahi sonrasında anlamlı bir düşüş elde edildi (z=-2.36; p=0.018). Buna ilaveten, cerrahi sonrasında hastanın NYHA sınıfındaki iyileşmesi 1 (dağılım 1-3) birimdi. Hastaların ameliyat öncesi ve sonrası NYHA sınıfları sırasıyla III (II-III) ve II (I-II) idi. Ameliyat sonrası NYHA sınıfındaki düşüş ile birlikte cerrahinin iyileştirme üzerine etkisi anlamlıydı (z=-2.26; p= 0.024). Yoğun bakım ünitesi ve hastanede ortalama kalış süreleri, sırasıyla üç (dağılım 2-14) ve 9.5 (dağılım 5-27) gündü. So nuç: Çalışma bulgularımıza göre, ayrıntılı bir ameliyat öncesi değerlendirme ve uygun hasta seçimi ile hekimler, cerrahi seçe-neğin kararında çekimser olmamalı ve hastaların yaşam kalitesini artırmak için çaba harcamalıdır.Anah tar söz cük ler: Akut pulmoner emboli; kronik tromboembolik pulmoner hipertansiyon; fonksiyonel kapasite; ortalama pulmoner arter basıncı; pulmoner tromboendarterektomi.Background:This study aims to reduce the uncertainity related to the prognosis after surgery of the acute pulmonary embolism (APE) and chronic thromboembolic pulmonary hypertension (CTPHT) patients, and to encourage physicians to consider surgical treatment options based on the evidence-based data which suggests that surgery offers the best chance for improvement in these patients. Methods: Between February 2009 and October 2010, seven cases (3 males, 4 females; mean age 43.8±18.5 years; range 25 to 73 years) who were operated on due to APE and CTPHT were included in this observational and retrospective study. The preand postoperative mean pulmonary artery pressure (mPAP), New York Heart Association (NYHA) functional class, and length of stay in the intensive care unit (ICU) and hospital along with the demographic, clinical and operational characteristics of the patients were r...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pulmonary embolectomy and thromboendarterectomy in seven cases

Hazan¹,

Şişli²,

Uğurlu³

et al. 2012

Turk Gogus Kalp Dama

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“…Unfortunately, the risk of surgical treatment for PE remains high. A recent study reported the perioperative mortality rate of pulmonary embolectomy to be 29% (15). We chose to treat this patient with systemic thrombolysis rather than subject him to the risk of thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

Should thrombolysis be contraindicated in patients with cerebral arteriovenous malformations?

Sumner

Golden

Hemphill

2002

Critical Care Medicine

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Known arteriovenous malformations or aneurysms are considered a contraindication to thrombolysis, although the true risk of thrombolysis-precipitated intracranial hemorrhage is unknown. We believe that this risk is low in the setting of a previously unruptured arteriovenous malformation or aneurysm. The decision to use systemic thrombolysis in a patient with a known vascular malformation should be individualized.

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“…8 Right ventricular dysfunction, assessed by echocardiography, has been shown to be an independent predictor of mortality. 9 Therapy options include heparin therapy (low molecular-weight heparins showing some advantages 10 ), warfarin therapy, caval filters, 11 thrombolysis with no one lytic agent showing superiority, 12 surgical embolectomy 13 and catheter embolectomy. 14 New catheter technologies might make this the treatment of choice in the future.…”

Section: Discussionmentioning

confidence: 99%

Mechanical circulatory assist for pulmonary embolism

et al. 2000

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Optimal management of acute pulmonary embolism remains controversial, despite advances in thrombolytic therapy. Haemodynamic instability and, in particular, right ventricular dysfunction is associated with poor outcomes. Urgent surgical embolectomy has been the treatment of choice in this category of patients. We present two cases in which percutaneous cardiopulmonary support (PCPS) was used as an adjunct to thrombolytic therapy for progressive circulatory collapse secondary to massive acute pulmonary embolism. This experience suggests that PCPS may offer an attractive option for a condition which continues to carry significant morbidity and mortality.

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Surgical Therapy of Fulminant Pulmonary Embolism: Early and Late Results

Abstract: Pulmonary embolectomy on cardiopulmonary bypass remains an adequate therapy in patients with failure of or contraindication to thrombolysis, and HIT is not a contraindication.

Cited by 53 publications

References 16 publications

Pulmonary embolectomy and thromboendarterectomy in seven cases

Pulmonary embolectomy and thromboendarterectomy in seven cases

Should thrombolysis be contraindicated in patients with cerebral arteriovenous malformations?

Mechanical circulatory assist for pulmonary embolism

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