Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism：a single-centre study in China

Abstract

Background: Acute pulmonary embolism (PE) is one of the most critical cardiovascular diseases. PE treatment ranges from anticoagulation, and systemic thrombolysis to surgical embolectomy and catheter embolectomy. Surgical pulmonary embolectmy (SPE) indications and outcomes are still controversial. Although there have been more favourable SPE reports over the past decades, SPE has not yet been considered broadly as an initial PE therapy and is still considered as a reserve or rescue treatment for acute massive PE when systemic thrombolysis fails. This study aimed to evaluate the early and midterm outcomes of SPE, which was a first-line therapy for acute central major PE in one Chinese single centre. Methods: A retrospective review of patients who underwent SPE for acute PE was conducted .Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular functionResults: Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2±48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping . Ventilatory support time was 78 h (range, 40-336 h), intensive care unit stay was 7 days (range, 3-13 days), and hospital stay was 16 days (range, 12-23 days).Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients’ right ventricle function improved postoperatively in follow-ups .There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively. Conclusions: SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups . SPE should play the same role as ST in algorithmic acute PE treatment.

Integration of Extracorporeal Membrane Oxygenation into the Management of High-Risk Pulmonary Embolism: An Overview of Current Evidence

“…Small modern series of surgical embolectomy for the management of acute PE reported a dramatic improvement in postoperative in-hospital mortality, ranging from 2.3 to 13.2%, with mortality associated largely with preoperative CPR. [87][88][89][90] We performed a systematic review and metaanalysis of 17 studies including a total of 327 PE patients managed with ECMO life support. 60 This study found that mechanical pulmonary reperfusion (including surgical [86%] and catheter-based embolectomy) seemed to be more effective than other strategies (i.e., systemic thrombolysis, catheter-directed thrombolysis, and stand-alone approach), for mitigating the mortality rate (OR, 0.44; 95% CI, 0.24-0.82), and demonstrated a similar risk of bleeding (OR, 1.27; 95% CI, 0.54-2.96).…”

Acute Massive and Submassive Pulmonary Embolism: Historical Considerations/Surgical Techniques of Pulmonary Embolectomy/Novel Applications in Donor Lungs with Pulmonary Emboli

“…29 30 31 A single-center study in China reported excellent results with an overall mortality 7.31%, with all three mortalities occurring in the massive PE group. 32 CPB has become synonymous with open heart procedures, and results continue to show that preoperative hemodynamic support may improve results of surgical pulmonary embolectomy, especially high-risk patients experiencing cardiac arrest. 33 34 John Gibbon would be proud to see how far we have come in the treatment of PEs; results continue to show that surgery could be offered as a safe and effective primary approach in both submassive and massive PE patients.…”