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. 2014 Dec 15;7(12):5362-75.
eCollection 2014.

Surgical embolectomy for acute massive pulmonary embolism

Senol Yavuz  1 , Faruk Toktas  1 , Tugrul Goncu  1 , Cuneyt Eris  1 , Arif Gucu  1 , Derih Ay  1 , Burak Erdolu  1 , Erhan Tenekecioglu  2 , Kemal Karaagac  2 , Hakan Vural  1 , Ahmet Ozyazicioglu  1
Affiliations

Surgical embolectomy for acute massive pulmonary embolism

Senol Yavuz et al. Int J Clin Exp Med. .

Abstract

Objective: Acute massive pulmonary embolism (PE) is associated with significant mortality rate despite diagnostic and therapeutic advances. The aim of this study was to analyze our clinical outcomes of patients with acute massive PE who underwent emergency surgical pulmonary embolectomy.

Methods: This retrospective study included 13 consecutive patients undergoing emergency surgical pulmonary embolectomy for acute massive PE at our institution from March 2000 to November 2013. The medical records of all patients were reviewed for demograhic and preoperative data and postoperative outcomes. All patients presented with cardiogenic shock with severe right ventricular dysfunction confirmed by echocardiography, where 4 (30.8%) of the patients experienced cardiac arrest requiring cardiopulmonary resuscitation before surgery.

Results: The mean age of patients was 61.8 ± 14 years (range, 38 to 82 years) with 8 (61.5%) males. The most common risk factors for PE was the history of prior deep venous thrombosis (n = 9, 69.2%). There were 3 (23.1%) in-hospital deaths including operative mortality of 7.7% (n = 1). Ten (76.9%) patients survived and were discharged from the hospital. The mean follow-up was 25 months; follow-up was 100% complete in surviving patients. There was one case (7.7%) of late death 12 months after surgery due to renal carcinoma. Postoperative echocardiographic pressure measurements demonstrated a significant reduction (P < 0.001). At final follow-up, all patients were in New York Heart Association class I and no readmission for a recurrent of PE was observed.

Conclusion: Surgical pulmonary embolectomy is a reasonable option and could be performed with acceptable results, if it is performed early in patients with acute massive PE who have not reached the profound cardiogenic shock or cardiac arrest.

Keywords: Acute massive pulmonary embolism; cardiopulmonary bypass; emergency operation; surgical embolectomy; thrombus.

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Figures

Figure 1
Figure 1
Diagnostic multimodal imaging of the massive pulmonary embolism. A. The short-axis echocardiographic display of the thrombus on the main pulmonary artery. B. Chest computed tomographic scan (axial section) showing saddle pulmonary embolus extending into both main pulmonary arteries.
Figure 2
Figure 2
Intraoperative appearance. A. A separate longitidunal incision of the right pulmonary artery between the aorta and superior vena cava for further exposure. B. The extraction of embolus gently as en bloc from the main pulmonary artery. C. The materials of thrombus removed from the main pulmonary artery and its branches in one of our patients.
See this image and copyright information in PMC

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