Surgical pulmonary embolectomy and catheter-directed thrombolysis for treatment of submassive pulmonary embolism

Kolkailah, Ahmed A.; Hirji, Sameer; Piazza, Gregory; Ejiofor, Julius I.; Val, Fernando Ramírez Del; Lee, Jiyae; McGurk, Siobhan; Aranki, Sary F.; Shekar, Prem; Kaneko, Tsuyoshi

doi:10.1111/jocs.13576

Cited by 22 publications

(10 citation statements)

References 33 publications

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“…Pulmonary embolectomy and EKOS are treatment alternatives for selected patients with intermediatehigh-risk PE who are not suitable for medical therapy. [27] A multidisciplinary approach is needed to tailor the most appropriate treatment option. Surgical pulmonary embolectomy is recommended for patients with high-risk PE in whom thrombolysis is contraindicated or has failed according to the ESC guidelines.…”

Section: Discussionmentioning

confidence: 99%

Analysis of pulmonary embolism patients treated with EkoSonicTM endovascular system

Şaylan

Çalışkan

Canoğlu

et al. 2020

Turk Gogus Kalp Dama

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Bu çalışmada, orta-yüksek riskli pulmoner emboli tanısıyla hastaneye yatırılan hastalardaki EkoSonic™ endovasküler sistem uygulamalarının etkinliği ve güvenliliği değerlendirildi. Ça lış ma pla nı: Ocak 2018-Mart 2019 tarihleri arasında, pulmoner emboli nedeniyle EkoSonic™ endovasküler sistemi kullanılarak ultrasonografi ile hızlandırılmış tromboliz yapılan toplam 15 hasta (7 erkek, 8 kadın; ort. yaş 64.7±17.8 yıl; dağılım, 35-90 yıl) retrospektif olarak incelendi. Pulmoner emboli tanısı, pulmoner bilgisayarlı tomografi anjiyografi ile konuldu. Hastaların tümü sağ ventrikül disfonksiyonu açısından ekokardiyografi ile değerlendirildi ve serum troponin I ve beyin natriüretik peptid düzeyleri kaydedildi. Bul gu lar: Hastaların işlem öncesinde ve sonrasında ortalama arteriyel kan gazı oksijen satürasyon değerleri sırasıyla %86.3±3.5 ve %94.2±2.5 olup, istatistiksel olarak anlamlı fark saptandı (p= 0.001). İşlem öncesinde ve sonrasında ortalama parsiyel oksijen basıncı değerleri 73.3±7.7 mmHg ve 90.7±5.0 mmHg olup, istatistiksel olarak anlamlı fark saptandı (p= 0.001). İşlem öncesinde ve sonrasında ortalama sağ ventrikül çapı açısından da istatistiksel olarak anlamlı bir fark vardı (p= 0.001). İşlem öncesinde ve sonrasında ortalama pulmoner arter basıncı sırasıyla 44±7.1 mmHg ve 36.3±4.5 mmHg olup, istatistiksel olarak anlamlı fark saptandı (p= 0.001). Hastaların %93.7'sinde işlem sonrasında komplikasyon gözlenmedi. So nuç: EkoSonic™ endovasküler system orta-yüksek riskli pulmoner emboli hastalarında kanama riskinde bir artışa neden olmaksızın sağ ventrikül disfonksiyonunu iyileştirdi; pulmoner arter basıncını azalttı ve oksijenasyonu düzeltti. Anah tarsöz cük ler: EkoSonic™ endovasküler sistem, pulmoner emboli, ultrasonografi ile hızlandırılmış tromboliz.

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Section: Discussionmentioning

confidence: 99%

Analysis of pulmonary embolism patients treated with EkoSonicTM endovascular system

Şaylan

Çalışkan

Canoğlu

et al. 2020

Turk Gogus Kalp Dama

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“…The poor success of clot removal, the risk of right ventricular perforation, and increased mortality currently limit the use of RAT in PE patients. Catheter‐directed thrombolysis is currently a better option for those acute PE patients who are not surgical candidates for a pulmonary embolectomy …”

Section: Discussionmentioning

confidence: 99%

The role of percutaneous vacuum-assisted thrombectomy for intracardiac and intravascular pathology

et al. 2018

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Vacuum-assisted thrombectomy (VAT) is a mechanical suction device that can be deployed to aspirate thrombi in the heart and vascular system. Successful percutaneous aspiration of iliocaval, right heart, and pulmonary arterial thrombi have been reported, in addition to the debulking of intravascular and intracardiac masses and vegetations. VAT is indicated for patients who are poor surgical candidates and/or have a contraindication to thrombolysis. This review discusses the mechanism, current results, potential clinical indications, and limitations of VAT for iliocaval and intracardiac mass removal.

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“…Improved surgical technique, improved ICU, and perioperative care in addition to multidisciplinary PE response teams have significantly improved the recent mortality rates associated with SPE in patients presenting with acute, massive, and submassive PEs. 41 These improved outcomes have led to a renewed interest in SPE with selected centers employing this strategy for patients with submassive PE.…”

Section: Surgical Embolectomy Outcomesmentioning

confidence: 99%

High-Risk Pulmonary Embolism: Embolectomy and Extracorporeal Membrane Oxygenation

Murray

Zapata

Keeling

2021

Semin Respir Crit Care Med

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Pulmonary embolism (PE) is a common medical condition associated with significant morbidity and mortality. It is the third most common cause of death in the United States. Historically, surgery for PE was associated with a high mortality rate, and this led to a significant decrease in the volume of operations being performed. However, significant improvements in patient selection and outcomes for surgical pulmonary embolectomy (SPE) at the end of the 20th century led to a renewed interest in the procedure. SPE was historically reserved for patients presenting with acute PE and hemodynamic collapse or cardiac arrest. Contemporary data has provided sufficient evidence to support earlier intervention for patients with acute PE who demonstrate clinical, laboratory, and echocardiographic signs of right ventricular dysfunction. Institutions with cardiac surgery capabilities are implementing SPE earlier for the management of both massive and submassive PEs with excellent short-term and long-term outcomes. Recently, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been employed successfully to treat patients with massive PE. Excellent short-term outcomes have been reported for patients suffering from PE after treatment with VA-ECMO. Further research, specifically with randomized controlled trials, is needed to determine the appropriate timing and patient selection for the use of VA-ECMO in patients with PE. These data would lead to updated guidelines and algorithms incorporating VA-ECMO and SPE for patients with PE.

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Surgical pulmonary embolectomy and catheter-directed thrombolysis for treatment of submassive pulmonary embolism

Abstract: Pulmonary embolectomy and CDT are important contemporary advanced treatment options for selected high-risk patients with submassive PE, who do not qualify for medical therapy.

Cited by 22 publications

References 33 publications

Analysis of pulmonary embolism patients treated with EkoSonicTM endovascular system

Analysis of pulmonary embolism patients treated with EkoSonicTM endovascular system

The role of percutaneous vacuum-assisted thrombectomy for intracardiac and intravascular pathology

High-Risk Pulmonary Embolism: Embolectomy and Extracorporeal Membrane Oxygenation

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