Acute pulmonary embolectomy

Abstract

Acute pulmonary embolism (PE) is a common condition frequently associated with a high mortality worldwide. It can be classified into non-massive, sub-massive and massive, based on the degree of haemodynamic compromise. Surgical pulmonary embolectomy, despite having been in existence for over 100 years, is generally regarded as an option of last resort, with expectedly high mortality rates. Recent advances in diagnosis and recognition of key qualitative predictors of mortality, such as right ventricular stress on echocardiography, have enabled the re-exploration of surgical pulmonary embolectomy for use in patients prior to the development of significant circulatory collapse, with promising results. We aim to review the literature and discuss the indications, perioperative workup and outcomes of surgical pulmonary embolectomy in the management of acute PE.

Surgical Embolectomy for Acute Massive and Submassive Pulmonary Embolism in a Series of 115 Patients

“…However, such treatment algorithms are based on limited data from small surgical series, and these practice patterns may be more reflective of scarce surgical expertise and availability rather than standards of care based on rigorous academic study. Indeed, increasing evidence suggests that pulmonary embolectomy might be considered first-line therapy for select patients [11][12][13]. Specifically, support is growing for early surgical intervention in patients with documented central PE and signs of right ventricular (RV) dysfunction before hemodynamic collapse [14][15][16][17][18][19].…”

Pulmonary Embolectomy in the Treatment of Submassive and Massive Pulmonary Embolism

“…Finally, 13 patients had a clot in transit, including 3 who had a right atrial clot traversing a patent foramen ovale into the left atrium, with distal arterial embolization imminent. In both scenarios, urgent surgical evacuation is recommended [1,14]. The potential for recurrent PE and subsequent paradoxical embolus in the setting of a patent foramen ovale makes its closure another benefit of surgical treatment [14].…”

“…In both scenarios, urgent surgical evacuation is recommended [1,14]. The potential for recurrent PE and subsequent paradoxical embolus in the setting of a patent foramen ovale makes its closure another benefit of surgical treatment [14]. …”

Thrombolytic Therapy Complemented by ECMO: Successful Treatment for A Case of Massive Pulmonary Thromboembolism with Hemodynamic Collapse

“…Surgical embolectomy can be another treatment option. However, mortality of surgical embolectomy in hemodynamically unstable patientis still high even though recent data have shown improved outcome (In-hospital mortality is 25% to 100% in patient with preoperative arrest) (9). Percutaneous catheter-directed thrombolysis or catheter thrombectomy is another treatment option (10, 11).…”

“…Although these procedures are potentially effective, they take more time to apply and show poor outcome in patient with cardiovascular collapse (12). Pulmonary thromboembolism progresses to cardiogenic shock and cardiac arrest due to right ventricular failure (9). In this situation, ECMO may be able to play a key role for emergent circulatory and respiratory support.…”