Surgical Embolectomy for Acute Pulmonary Thromboembolism

Abstract

急性肺動脈血栓塞栓症(APTE)は急激な経過をたどる場合があり当院では積極的に外科的血栓摘除を行っTreatment of acute pulmonary thromboembolism(APTE)in patients with hemodynamic instability still remains controversial. We analyzed the outcome and validity of surgical pulmonary embolectomy for APTE. Between January of 2004 to December of 2010, 15 patients underwent emergency surgical pulmonary embolectomy using cardiopulmonary bypass with beating heart. Our operative indications were ; within 7 days from onset, hemodynamic instability, bilateral pulmonary artery obstruction or unilateral obstruction with central clot and right ventricular dysfunction. Ten patients presented in cardiogenic shock, two of whom showed cardiac arrest and required cardiopulmonary resuscitation before operation. One patient required percutaneous cardiopulmonary support. Median follow up period is 33 months(range 3 to 86 months). All patients survived the operation, but 3 patients died in the hospital on post operative day 11(massive cerebral infarction), day 18(brain hypoxia)and day 25 (multiorgan failure). Two of them had cardiac arrest and received cardiopulmonary resuscitation before operation. Hospital mortality was 20%. And all patients left the hospital on foot except one patient who had been bedridden by myotonic dystrophy before operation. No patients died or showed symptoms of pulmonary hypertension after discharge. Prompt diagnosis and surgical pulmonary embolectomy before threatening fatal condition improves the outcome of embolectomy. Jpn. J. Cardiovasc. Surg. 41 : 58-62