Outcome after surgical embolectomy for acute pulmonary embolism

Abstract

AimsPatients with pulmonary embolism (PE) and contraindications for or failed thrombolysis are at the highest risk for PE-related fatal events. These patients may benefit from surgical embolectomy, but data concerning this approach are still limited.MethodsThe method used here was retrospective data analysis of 103 patients who underwent surgical embolectomy from 2002 to 2020 at our department.ResultsMean age was 58.4 (±15.1) years. Fifty-eight (56.3%) patients had undergone recent surgery; the surgery was tumor associated in 32 (31.1%) cases. Thirty (29.1%) patients had to be resuscitated due to PE, and 13 (12.6%) patients underwent thrombolysis prior to pulmonary embolectomy. Fifteen (14.5%) patients were placed on extra corporeal membrane oxygenation (ECMO) peri-operatively. Five patients (4.9%) died intra-operatively. Neurological symptoms occurred in four patients (3.9%). Thirty-day mortality was 23.3% (n = 24). Re-thoracotomy due to bleeding was necessary in 12 (11.6%) patients. This parameter was also identified as an independent risk factor for mortality.ConclusionSurgical pulmonary embolectomy resulted in survival of the majority of patients with PE and contraindications for or failed thrombolysis. Given the excessive mortality when left untreated, an operative approach should become a routine part of discussions concerning alternative treatment options for these patients.

Extracorporeal Membrane Oxygenation for Pulmonary Embolism: A Systematic Review and Meta-Analysis

“…Of 2318 references screened, we sought the full text for 370 potentially relevant publications. Some 351 full-text articles were available, from which we included 39 observational studies totalling 1,177,998 patients (6409 ECMO and 1,171,589 non-ECMO) in the meta-analysis ( Figure 1 , Table S4 ) [ 9 , 10 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ], of which 13 were cohort studies and 26 were case series. There were 14 studies from Europe, 14 from Asia, and 11 from North America.…”

“… Pooled risk ratio comparing patients receiving ECMO vs. no ECMO for high-risk pulmonary embolism [ 29 , 31 , 37 , 38 , 40 , 41 , 46 , 48 , 58 , 60 , 62 ]. …”

“… Subgroup analysis of mortality for patients receiving extracorporeal membrane oxygenation alone compared to ECMO with catheter-directed therapies (CDT), surgical embolectomy (SE), or systemic thrombolysis (ST) for pulmonary embolism [ 9 , 10 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. …”

Right ventricular thrombosis: from a case report to pathophysiology mechanisms and current treatment options

“…This is further supported by recent results of a retrospective study of 103 patients undergoing surgical pulmonary embolectomy between 2002 and 2020, all showing signs of ventricular dysfunction, of whom 57 (55.3%) had contraindications for systemic thrombolysis. Data show that most patients presented with cardiogenic shock and preoperative cardiopulmonary resuscitation was necessary in 30 (29.1%) patients, with a 30-day mortality of 23.3%, which was higher for those who needed ECMO 32 …”

“…Data show that most patients presented with cardiogenic shock and preoperative cardiopulmonary resuscitation was necessary in 30 (29.1%) patients, with a 30-day mortality of 23.3%, which was higher for those who needed ECMO. 32 Anticoagulation therapy is recommended as an additional treatment following thrombolysis or surgical embolectomy for patients with RVT and PE. Anticoagulant drug dosage and duration are the same as suggested for PE.…”