Surgical embolectomy for high-risk acute pulmonary embolism is standard therapy.
OBJECTIVES
Acute massive pulmonary embolism (AMPE) is a life-threatening condition that often induces rapid haemodynamic deterioration. The mortality of surgical embolectomy is still poor in patients with preoperative cardiopulmonary arrest (CPA). We analysed the outcome of surgical pulmonary embolectomy for haemodynamically unstable patients.


METHODS
Thirty-one patients underwent surgical embolectomy for haemodynamically unstable AMPE. The indications for surgical embolectomy were (i) <7 days from onset, (ii) haemodynamically unstable, (iii) massive clots in bilateral pulmonary arteries or unilateral pulmonary artery occlusion with a floating clot in the main pulmonary artery or right atrium and (iv) right ventricular dilatation in transthoracic echocardiography. Eight (25.8%) patients had cardiopulmonary arrest. Nine (29.0%) patients received preoperative percutaneous cardiopulmonary support (PCPS). The mean original Pulmonary Embolism Severity Index (PESI) and simplified PESI scores were 158 ± 51 and 2.4 ± 0.9, respectively.


RESULTS
The hospital mortality rate was 12.9% (n = 4). Two patients died of hypoxia. Multiorgan failure occurred by sepsis and by right ventricular failure in 1 patient each. No hospital deaths occurred in patients with preoperative PCPS (n = 9). The mean follow-up period was 47.7 ± 35.9 months (range, 3 - 134 months) and the 5-year survival rate was 83.2 ± 6.9%. Postoperative pulmonary artery pressure significantly decreased from 52.7 to 25.8 mmHg.


CONCLUSIONS
Surgical embolectomy for high-risk AMPE patients has an excellent operative mortality and long-term outcome. Preoperative PCPS may lead to an immediate stable haemodynamic state and improve surgical embolectomy results, especially in high-risk patients (e.g. those with preoperative CPA). Surgical embolectomy for AMPE is an established operation and considered as the first-line therapy.
['Shiomi|Daisuke|D|', 'Kiyama|Hiroshi|H|', 'Shimizu|Masatsugu|M|', 'Yamada|Muneaki|M|', 'Shimada|Naohiro|N|', 'Takahashi|Aya|A|', 'Kaki|Nobuaki|N|']
D000328:Adult D000368:Aged D017128:Embolectomy D005260:Female D006439:Hemodynamics D017052:Hospital Mortality D006801:Humans D008297:Male D008875:Middle Aged D011655:Pulmonary Embolism D015996:Survival Rate D016896:Treatment Outcome
Surgical embolectomy Percutaneous cardiopulmonary support Massive pulmonary thromboembolism