Surgical pulmonary embolectomy and catheter-based therapies for acute pulmonary embolism: A contemporary systematic review

Loyalka, Pranav; Ansari, Muhammad Zubair Ahmad; Cheema, Faisal H.; Miller, Charles C.; Rajagopal, Sudarshan; Rajagopal, Keshava

doi:10.1016/j.jtcvs.2018.05.085

Cited by 41 publications

(32 citation statements)

References 97 publications

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“…2,4,5,15,16) Significant hemorrhagic complications occur in nearly 25% of thrombolysis patients compared to 15% in SPE. 5,15,31) Recurrent PE is a known complication of all treatment modalities, but tend to occur more frequently following thrombolysis (21%) than SPE (7.7%). 5,15,16) Regardless of treatment strategy, IVC filter placement should be performed either during the index procedure or shortly thereafter.…”

Section: Discussionmentioning

confidence: 99%

Current Management of Acute Pulmonary Embolism

Licha

McCurdy

Maldonado

et al. 2020

ATCS

103

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Purpose: Acute pulmonary embolism (PE) remains a significant cause of morbidity and requires prompt diagnosis and management. While non-surgical approaches have supplanted surgery as primary treatment, surgical pulmonary embolectomy (SPE) remains a vital option for select patients. We review the current management of acute PE, with a focus on surgical therapy. Methods: A PubMed search was performed to identify literature regarding PE and treatment. Results were filtered to include the most comprehensive publications over the past decade. Results: PE is stratified based on presenting hemodynamic status or degree of mechanical pulmonary arterial occlusion. Although systemic or catheter-guided fibrinolysis is the preferred first-line treatment for the majority of cases, patients who are not candidates should be considered for SPE. Studies demonstrate no mortality benefit of thrombolysis over surgery. Systemic anticoagulation is a mainstay of treatment regardless of intervention approach. Following surgical embolectomy, direct oral anticoagulants (DOACs) have been shown to reduce recurrence of thromboembolism. Conclusions: Acute PE presents with varying degrees of clinical stability. Patients should be evaluated in the context of various available treatment options including medical, catheter-based, and surgical interventions. SPE is a safe and appropriate treatment option for appropriate patients.

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Section: Discussionmentioning

confidence: 99%

Current Management of Acute Pulmonary Embolism

Licha

McCurdy

Maldonado

et al. 2020

ATCS

103

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“…Our patient was initially treated for her DVT using anticoagulants (unfractionated heparin), which was ineffective. The fast decline of the patient, the high mortality risk of this particular thrombus and the relative contraindication for thrombolytic treatment due to her recent history of surgical intervention [ 24 ] limited the choice in the course of treatment to emergency surgical embolectomy [ 25 ]. We believe that surgical embolectomy is an adequate treatment for patients with hemodynamic instability, after ruling out other causes of hemodynamic collapse [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment in a High-Risk Pulmonary Embolism: Case Report

et al. 2021

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We present the case of a 35-year-old woman who had a high-risk pulmonary embolism (according to ESC risk stratification for pulmonary embolism) after she had undergone a Caesarion section. Postoperatively, she presented with acute left lower limb pain, swelling and erythema. A diagnosis was made of deep vein thrombosis (DVT) of the ilio-femoral and popliteal veins. She was started on anticoagulant therapy, which proved to be inefficient, the patient developing a left calf and thigh oedema and shortness of breath. A CT scan revealed high-risk embolus located in the right atrium and through the tricuspid valve. The decision was made to refer her to a cardiovascular surgeon. During her preoperative evaluation, the patient became hemodynamically unstable and was rushed into the operating room, severely desaturated, bradycardic, without consciousness, with severe hypotension. On the basis of the severe state of the patient and the CT scan findings we performed an emergency pulmonary embolectomy, with the patient on cardio-pulmonary by-pass, without cross-clamping the aorta, using a modified Trendelenburg procedure. This case supports using open pulmonary embolectomy for patients with hemodynamic instability on the basis of clinical diagnosis.

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“…Although catheter-directed therapy or surgical embolectomy can be considered in such cases, the prognosis had been very poor [2]. According to a systematic review by Loyalka et al, the mortality rates in acute PTE with CPR had remained considerably high at 52% after catheter-directed therapy and 46.3% after surgical therapy [4]. Keeling et al reported a 32.1% mortality rate for patients who received surgical therapy [5], and the Japanese Society for Cardiothoracic Surgery also reported a high mortality rate (43.8%) [6].…”

Section: Discussionmentioning

confidence: 99%

Potential benefit of non-cardiac arrested thromboembolectomy of acute pulmonary embolism for the impaired right ventricular function

Okada

Watanuki

Sugiyama

et al. 2019

Gen Thorac Cardiovasc Surg

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Objectives Acute pulmonary thromboembolism is a fatal condition with high mortality rate in patients with hemodynamic collapse. Early diagnosis and aggressive treatment after circulatory collapse due to pulmonary thromboembolism are important. Although catheter-directed therapy or surgical thromboembolectomy could be considered, the prognosis of such cases is poor. Methods We reviewed nine consecutive patients who underwent surgical intervention for acute pulmonary thromboembolism requiring cardiopulmonary resuscitation from March 2010 to May 2017. The patients' demographics, risk factors, operative and postoperative outcomes were retrospectively analyzed. All nine patients who experienced cardiopulmonary arrest or pulseless electrical activity had received cardiopulmonary resuscitation, including endotracheal intubation with cardiac massage. Computed tomography revealed massive pulmonary thromboembolism. Percutaneous cardiopulmonary support was initiated in six cases. Pulmonary thromboembolectomy was performed on a beating heart without aortic crossclamping in all patients Results The mean operation time was 251.9 ± 74.7 min. Among the six patients who received preoperative percutaneous cardiopulmonary support, three were able to wean off cardiopulmonary bypass during the surgery. The other three cases were able to wean off within 3 days postoperatively. The mean postoperative intubation time was 56.3 h. No mortality was observed. All patients were discharged with New York Heart Association functional class I without any neurological complications. No patients developed major and residual thrombi in the pulmonary artery upon postoperative computed tomography. Conclusions Pulmonary thromboembolectomy on a beating heart for acute pulmonary thromboembolism may be beneficial for minimizing right ventricular damage and improving clinical outcomes.

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Surgical pulmonary embolectomy and catheter-based therapies for acute pulmonary embolism: A contemporary systematic review

Cited by 41 publications

References 97 publications

Current Management of Acute Pulmonary Embolism

Current Management of Acute Pulmonary Embolism

Surgical Treatment in a High-Risk Pulmonary Embolism: Case Report

Potential benefit of non-cardiac arrested thromboembolectomy of acute pulmonary embolism for the impaired right ventricular function

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