Surgical Pulmonary Embolectomy: Experience in a Series of 37 Consecutive Cases

Edelman, James; Okiwelu, Ngozichukwuka; Anvardeen, Kalilur; Joshi, Pragnesh; Murphy, Brooke; Sanders, Lucas; Newman, Mark; Passage, Jürgen

doi:10.1016/j.hlc.2016.03.010

Cited by 21 publications

(23 citation statements)

References 13 publications

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“…Pasrija and colleagues achieved 100% survival (28/28) in the submassive group, 88% survival (16/18) in the massive without arrest subset, and 78% survival (7/9) in the massive with arrest group. These outcomes are similar to those in recent publications from Edelman and colleagues, 2 Keeling and colleagues, 3 and Neely and colleagues, 4 which have detailed 30-day mortalities of 2.7%, 11.7%, and 6.6%, respectively, after surgical pulmonary embolectomy. These recent results are in stark contrast to earlier reviews by Kalra and colleagues, 5 Kilic and colleagues, 6 and Meyer and colleagues, 7 with 26.3%, 27.2%, and 37.5% 30-day mortality, respectively.…”

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confidence: 89%

Play it again…Dr Gibbon

Baciewicz

2018

The Journal of Thoracic and Cardiovascular Surgery

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If Dr John Gibbon had reviewed ''Outcomes After Surgical Pulmonary Embolectomy for Acute Submassive and Massive Pulmonary Embolism: A Single Center Experience'' by Pasrija and colleagues, 1 he would have experienced a d ej a vu moment. While caring for a woman who would eventually die from a pulmonary embolism in 1931, Dr Gibbon forged the idea for developing a machine to oxygenate the blood and save his patient's life. His later development of cardiopulmonary bypass ushered in the era of open-heart surgery and the possibility of surgical pulmonary embolectomy with circulatory support.This manuscript from the University of Maryland reports an outstanding overall 30-day mortality of 7% for surgical pulmonary embolectomy. Pasrija and colleagues achieved 100% survival (28/28) in the submassive group, 88% survival (16/18) in the massive without arrest subset, and 78% survival (7/9) in the massive with arrest group. These outcomes are similar to those in recent publications from Edelman and colleagues, 2 Keeling and colleagues, 3 and Neely and colleagues, 4 which have detailed 30-day mortalities of 2.7%, 11.7%, and 6.6%, respectively, after surgical pulmonary embolectomy. These recent results are in stark contrast to earlier reviews by Kalra and colleagues, 5 Kilic and colleagues, 6 and Meyer and colleagues, 7 with 26.3%, 27.2%, and 37.5% 30-day mortality, respectively.These markedly improved results are likely related to several factors. First, surgical techniques that isolate the pulmonary circulation, avoid aortic crossclamping, use intermittent short periods of circulatory arrest, and employ retrograde pulmonary perfusion 8 have contributed. Second, anesthetic management with drugs to manipulate the pulmonary vasculature, avoidance of positive airway pressure, and the use of transesophageal echo have assisted induction of these unstable patients and improved their postoperative care.Third, selection of patients, ie, avoiding those who have had extended periods of cardiopulmonary arrest or refusing operation on patients in cardiopulmonary arrest, may have affected reported results. Keeling and colleagues 3 reported a 30-day mortality of 32% in surgical embolectomy patients with preoperative cardiopulmonary arrest, Carvalho and colleagues 9 mentioned an 85% 30-day mortality in salvage cases, and Aymard and colleagues 10 noted 27% short-term mortality in patients having surgical pulmonary embolectomy after failure of thrombolytic therapy.Fourth, the ability to stabilize and rescue a patient at bedside with percutaneous circulatory support (veno-arterial extracorporeal membrane oxygenator) allows an operation on a patient who is well-oxygenated, nonacidotic, not requiring inotropic support, and with a clearer decision window. Takahashi and colleagues 11 reported a series of 24 patients, with 19 in cardiogenic shock and 16 on preoperative percutaneous veno-arterial extracorporeal membrane oxygenator support with a surprising 30-day mortality of only 12.5%. In the study from Pasrija and colleagues, 1 4 of 18 in the mass...

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confidence: 89%

Play it again…Dr Gibbon

Baciewicz

2018

The Journal of Thoracic and Cardiovascular Surgery

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“…The indication of SPE was extended and submassive PE with RVD accepted SPE treatment.The mortality rate of SPE has gradually decreased. Lehnert 11 reported SPE mortality rate of 6%, and more excellent results of SPE were reported 12,13,14 . Cho 15 reported that SPE had a lower cardiac mortality risk than thrombolysis in PE patients with haemodynamic stability.…”

Section: Discussionmentioning

confidence: 93%

Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism：a single-centre study in China

Wang

Chen

Qiu

et al. 2020

Preprint

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Background: Acute pulmonary embolism (PE) is one of the most critical cardiovascular diseases. PE treatment ranges from anticoagulation, and systemic thrombolysis to surgical embolectomy and catheter embolectomy. Surgical pulmonary embolectmy (SPE) indications and outcomes are still controversial. Although there have been more favourable SPE reports over the past decades, SPE has not yet been considered broadly as an initial PE therapy and is still considered as a reserve or rescue treatment for acute massive PE when systemic thrombolysis fails. This study aimed to evaluate the early and midterm outcomes of SPE, which was a first-line therapy for acute central major PE in one Chinese single centre. Methods: A retrospective review of patients who underwent SPE for acute PE was conducted .Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular functionResults: Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2±48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping . Ventilatory support time was 78 h (range, 40-336 h), intensive care unit stay was 7 days (range, 3-13 days), and hospital stay was 16 days (range, 12-23 days).Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients’ right ventricle function improved postoperatively in follow-ups .There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively. Conclusions: SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups . SPE should play the same role as ST in algorithmic acute PE treatment.

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“…Lehnert P (14) reported 33cases of surgical treatment with 2 death,the mortality was 6% Worku B (15) reported 20 cases surgical treatment for PE with only 1 case death,the mortality was 5%. Yalamanchili (16) reported with 8% mortality of surgical treatment, Edelman JJ (17) reported 37cases pulmonary embolectomy with 2 case death,the mortaliry was 5.4%.Aymard T 18 reported 28 cases pulmonary embolectomy with 2 cases death,mortality was only 3.6%. Cho (19) reported SE had lower cardiac mortality risk than thrombolysis in PE patients with heamodynamic stable.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Acute Pulmonary Embolectomy Taken as to be the First Line Treatment for Massive and Submassive Pulmonary Embolism: Experience from One Single Center in China

Wang

Chen

Qiu

et al. 2020

Preprint

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Backgroud: Acute pulmonary embolism (PE) is one of the most critical cardiovascular disease. The treatment for PE depends on the severity of disease including anticoagulation, systemic thrombolysis, surgical embolectomy,and catheter embolectomy. The indication of surgical pulmonary embolectomy is still controvery. Although there have been more favourable reports of the of surgical embolectomy (SE) over past decades, SE has still been used as a resort or rescue treatment for acute massive PE with significant hemodynamically unstable or present with cardiogenic shock or patients whose thrombolysis failed，therefore the high mortality of pulmonary surgical embolectomy was still reported. SE has not yet been accepted broadly as initial therapy in the algorithm for massive and submassive PE.Objective : The purpose of this study is to evaluate the early and midterm outcome of surgical pulmonary embolectomy which was taken as the first line therapy for acute central major pulmonary embolism in one single center in ChinaMethods: A retrospective review of patients who underwent surgical pulmonary embolectomy for acute pulmonary embolectomy was conducted from July of 2005 to Sept of 2019 at a single heart center in China. Patients with chronic thrombus or thrombendrterectomy were excluded.The risk factors for morbidity and mortality of the surgical pulmonary embolectomy were reviewed, The institutional echocardiographic database was searched for follow-up studies to compare markers of right ventricular function.Results: A total of 41 patients were included for the study, 17 cases (41.5%) had submassive PE and 24 (58.5%) had massive pulmonary embolism required preoperative positive inotropic treatment. Mean cardiopulmonary bypass time was 103.2±48.9 minutes, and 10 patients (24.4.%) underwent procedures without aortic cross-clamping. Ventilatory support time was 80.6±21.3hours. ICU stay was 4.51±3.23 days. Hospital stay was 12.8±6.4days. There was operative mortality 3 (7.32%) for massive pulmonary embolism and no death case of submassive pulmonary embolism. For massive PE patients, if the first choice treatment was surgical embolectomy, the mortality was low,only 2.56%, even though there were 2 cases suffered from cardiac arrest preoperatively. However, if 2 cases who received systemic thromblysis firstly were included in the datus,the mortality rate of SE increased to 12.5%. All cases had echocardiography results available for follow-up at discharge,and 30 cases at three months, only 10 cases at one years after surgical embolectomy. There were no death event related with recurrent PE in the follow-up,but 3 patents died of cerebral incranal bleeding, gastric cancer and gastric cancer at 1 year,3 years and 8 years after surgical embolectomy respectively.Conclusions: In this small retrospective single center experience, SE presented with low mortality rate when it was rendered as the first line treatment in selected patients for massive and submassive acute pulmonary embolism. SE should play the the same role as ST in the treatment algorithm for acute PE. Echocardiographic showed right ventricular function was improved in the early and midterm follow- up term

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Surgical Pulmonary Embolectomy: Experience in a Series of 37 Consecutive Cases

Cited by 21 publications

References 13 publications

Play it again…Dr Gibbon

Play it again…Dr Gibbon

Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism：a single-centre study in China

Clinical Outcome of Acute Pulmonary Embolectomy Taken as to be the First Line Treatment for Massive and Submassive Pulmonary Embolism: Experience from One Single Center in China

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