Surgical embolectomy for high-risk acute pulmonary embolism is standard therapy

Shiomi, Daisuke; Kiyama, Hiroshi; Shimizu, Masatsugu; Yamada, M; Shimada, Naoyuki; Takahashi, Aya; Kaki, Nobuaki

doi:10.1093/icvts/ivx091

Cited by 10 publications

(4 citation statements)

References 22 publications

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“…3 If absolute contraindications to thrombolysis are present and if performed in an experienced center in HRPE surgical embolectomy, in addition to anticoagulation, is often used. 3,[9][10][11] Preoperative thrombolysis increases the risk of bleeding, but it is not an absolute contraindication to surgical embolectomy. 12 In the case of early embolectomy before the hemodynamic collapse, perioperative mortality rates of 6% or less have been reported.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy

Bunc

Steblovnik

Zorman

et al. 2020

Radiology and Oncology

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BackgroundHigh-risk pulmonary embolism is associated with a high early mortality rate. We report our experience with percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy.Patients and methodsThis was a retrospective analysis of consecutive patients with high-risk pulmonary embolism and contraindications to thrombolytic therapy. They were treated with percutaneous mechanical thrombectomy which included thrombectomy and additional thrombus aspiration when needed. Clinical parameters and survival to discharge were measured.ResultsFrom November 2005 to September 2015 we treated 25 patients with a mean age of 62.6 ± 12.7 years, 64% were men. Mean simplified Pulmonary Embolism Severity Index was 2.9. Mean maximum lactate levels were 7.8 ± 6.6 mmol/L, vasopressors were used in 77%, and 59% needed mechanical ventilation. Mechanical treatment included thrombus fragmentation complemented with aspiration (56%) and aspiration using Aspirex®S catheter (44%). Local (5 patients; 20%) and systemic (3 patients; 12%) thrombolytics were used as a salvage therapy. We observed nonsignificant improvements in systemic blood pressure (100 ± 41 mm Hg vs 119 ± 34; p = 0.100) and heart frequency (99 ± 35 min-1vs 87 ± 31 min-1; p = 0.326) before and after treatment, respectively. Peak systolic tricuspid pressure gradient was significantly lower after treatment (57 ± 14 mm Hg vs 31 ± 3 mm Hg; p = 0.018). Overall the procedure was technically successful in 20 patients (80%) and 17 patients (68%) survived to hospital discharge.ConclusionsIn patients with high-risk pulmonary embolism who cannot receive thrombolytic therapy, percutaneous mechanical thrombectomy is a promising alternative to reduce pulmonary artery pressure.

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Section: Discussionmentioning

confidence: 99%

Percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy

Bunc

Steblovnik

Zorman

et al. 2020

Radiology and Oncology

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“…10 In contrast, major reports on pulmonary embolectomy have shown significantly longer intensive care unit lengths of stay, longer hospitalization periods, and consequently higher costs of surgery than with medical management. 11,12 Barrios et al 13 recently reported no differences between anticoagulation alone and reperfusion therapy with respect to all-cause death (6.2% vs. 14%, respectively) or PErelated mortality (4.7% vs. 7.8%, respectively) through a propensity score matched-pairs analysis. Nevertheless, the authors failed to provide any information concerning the type of RHT in that study.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Half-dose thrombolytic therapy in patients with right heart thrombi

et al. 2019

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The management of floating right heart thrombi (FRHT) in patients with acute pulmonary emboli is controversial. Several recent case series have revealed similar efficacy and better survival rates with systemic thrombolytic therapy than with surgery. In this case series, we present our experience with the efficacy of “half-dose” or “safe-dose” thrombolytic therapy in the resolution of FRHT. Five patients who were admitted with confirmed acute pulmonary emboli and FRHT were included in the present report. Half-dose thrombolytic therapy (50 mg of alteplase) was administered to the patients. Follow-up echocardiography revealed complete resolution of the FRHT and considerable improvement in the right heart function. No bleeding events were recorded. Our small case series shows the efficacy and safety of half-dose thrombolytic therapy in FRHT resolution in a group of patients with high bleeding risk. Our findings should be tested in larger populations.

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“…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.…”

Section: Validationmentioning

confidence: 99%

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

Russell¹,

Keshavamurthy

2022

Int J Angiol

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Pulmonary embolectomy has a chequered history but the quest to surgically treat a patient diagnosed with pulmonary embolism effectively spurred the development of cardiopulmonary bypass and a new dawn for cardiac surgery. The advent of cardiopulmonary bypass, extracorporeal membrane oxygenation, and computed tomography pulmonary angiogram has allowed rapid diagnosis and made surgical pulmonary embolectomy a relatively safe procedure that should be considered when indicated. Pulmonary emboli in donor lungs, often get rejected for transplantation. Ex vivo lung perfusion is among newly available technology with the ability to not only recondition marginal lungs but also treat donor lung pulmonary embolisms, effectively increasing the donor pool.

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Surgical embolectomy for high-risk acute pulmonary embolism is standard therapy

Cited by 10 publications

References 22 publications

Percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy

Percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy

Half-dose thrombolytic therapy in patients with right heart thrombi

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

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