Pulmonary embolectomy: recommendation for early surgical intervention

Enisa M Carvalho; Francisco Igor B Macedo; Anthony L Panos; Marco Ricci; Tomas A Salerno

doi:10.1111/j.1540-8191.2009.00986.x

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Pulmonary embolectomy: recommendation for early surgical intervention

Journal article

Peer reviewed

Pulmonary embolectomy: recommendation for early surgical intervention

Enisa M Carvalho, Francisco Igor B Macedo, Anthony L Panos, Marco Ricci and Tomas A Salerno

Journal of cardiac surgery, Vol.25(3), pp.261-266

05/2010

DOI: 10.1111/j.1540-8191.2009.00986.x

PMID: 20149009

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Abstract

Acute pulmonary embolism (PE) is a life-threatening disease which often results in death if not diagnosed early and treated aggressively. Despite all efforts at improving outcomes, there is no consensus on the management of acute severe PE. From May 2000 to June 2009, 16 consecutive patients underwent surgical pulmonary embolectomy at our institution. Mean age was 45 +/- 17 years (range, 14 to 76) with nine (56%) males and seven (43%) females. Preoperatively, all cases were classified as massive PE; seven (43%) patients were in hemodynamic collapse and emergently underwent operation while receiving cardiopulmonary resuscitation. There were nine (56%) urgent/emergent and seven (44%) salvage patients undergoing surgical pulmonary embolectomy. Of nine nonsalvage patients, seven (77%) patients presented with moderate to severe right ventricular (RV) dilation/dysfunction. Mean cardiopulmonary bypass time was 43 +/- 41 minutes (range, 9 to 161). Mean follow-up duration was 48 +/- 38 months (range: 0.3 to 109), with seven in-hospital deaths (43%): mortality was 11% (1/9) in emergent operations and 85% (6/7) in salvage operations. Surgical pulmonary embolectomy should be considered early in the management of hemodynamically stable patients with PE who show evidence of RV dilation and/or failure, as it is associated with satisfactory outcomes. Conversely, pulmonary embolectomy has dismal results under salvage conditions. Revision of current guidelines for the surgical management of this condition may be warranted.

Acute Disease

Prospective Studies

Hospital Mortality

United States

Ventricular Dysfunction, Right

Humans

Middle Aged

Kaplan-Meier Estimate

Male

Pulmonary Embolism - mortality

Young Adult

Cardiopulmonary Resuscitation

Algorithms

Adolescent

Adult

Female

Aged

Hemodynamics

Pulmonary Embolism - surgery

Embolectomy - methods

Details

Title: Subtitle: Pulmonary embolectomy: recommendation for early surgical intervention
Creators: Enisa M Carvalho - Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA
Francisco Igor B Macedo
Anthony L Panos
Marco Ricci
Tomas A Salerno
Resource Type: Journal article
Publication Details: Journal of cardiac surgery, Vol.25(3), pp.261-266
Publisher: United States
DOI: 10.1111/j.1540-8191.2009.00986.x
PMID: 20149009
ISSN: 0886-0440
eISSN: 1540-8191
Language: English
Date published: 05/2010
Academic Unit: Surgery; Cardiothoracic Surgery
Record Identifier: 9984051770002771

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