Surgical Pulmonary Embolectomy

Poterucha, Timothy J.; Bergmark, Brian A; Aranki, Sary F.; Kaneko, Tsuyoshi; Piazza, Gregory

doi:10.1161/circulationaha.115.015916

Cited by 20 publications

(14 citation statements)

References 22 publications

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“…Pumonarythromboembolectomy is one of the oldest performed cardiac surgeries [7][8] . However due to high mortality it was rarely performed even with the advent of cardiopulmonary bypass 9 .…”

Section: Resultsmentioning

confidence: 99%

Surgical Management of Acute Pulmonary Thromboembolism: our Experience

Raut¹,

Mishra²,

Mohapatra³

et al. 2016

IOSR

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Acute pulmonary thromboembolism (PTE) can be a life threatening complication of deep vein thrombosis. Surgical embolectomy is a rarely performed and is only reserved for hemodynamically unstable patients, those with massive pulmonary thromboembolism and those with failed thrombolysis therapy. We reviewed the results of surgical pulmonary embolectomy performed in our institute over the last four years. Data was retrospectively studied of 28 patients who underwent pulmonary embolectomy in our institute over the last four years i.e. from 2012 to 2016. Demographic data, clinical presentation and outcomes were analyzed. Clinical presentation included dyspnea (82%), hemodynamic instability requiring continuous vasopressor support (36%), echocardiographic evidence of right ventricular dilatation (82%). There was 3% mortality rate in our study which is comparably low with previous studies. Our series implies the benefit of early consideration and performance of pulmonary embolectomy in these critically ill patients.

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Section: Resultsmentioning

confidence: 99%

Surgical Management of Acute Pulmonary Thromboembolism: our Experience

Raut¹,

Mishra²,

Mohapatra³

et al. 2016

IOSR

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“…Surgical pulmonary embolectomy has been associated with mortality rates exceeding 30% in some studies and has thus been underutilized. 6,10 In a recent large-scale New York population study spanning 14 years, of those diagnosed with acute PE and treated with either thrombolysis or surgical embolectomy, only 12.2% underwent surgical pulmonary embolectomy. 11 Although systemic and catheter-directed anticoagulation has arisen as the treatment of choice for most cases of PE, the effectiveness of these approaches remains suboptimal in cases of massive PE.…”

Section: Discussionmentioning

confidence: 99%

“…Thus far in our experience we have not observed any instances of acute respiratory distress syndrome, acute kidney injury, mediastinitis, vocal cord palsy, or hypoxic brain damage, which have been reported in other series of surgical pulmonary embolectomy. 2,6 Additionally thoracoscopy greatly enhances inspection of the segmental and subsegmental arterial branches ensuring complete removal of thrombus. The novel use of thoracoscopy in this manner allows minimally invasive access through a 5-cm incision without compromising completeness of clot extraction (an issue that has plagued success of previous minimally invasive methods of embolectomy).…”

Section: Discussionmentioning

confidence: 99%

“…As such, surgical embolectomy has classically been associated with poor outcomes and increased rates of patient morbidity and mortality. 2,6 These outcomes can largely be attributed to the strict criteria used to determine which patients are eligible for surgical intervention, leaving only the highest-risk patients operated upon. However, newer, innovative surgical techniques have illustrated that surgical pulmonary embolectomy can be performed successfully, and less invasively, in patients with massive PE who do not present in extremis.…”

Section: Introductionmentioning

confidence: 99%

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Initial Experience with Non-Sternotomy Minimally Invasive Pulmonary Embolectomy with Thoracoscopic Assistance

Greenberg

Gupta

Lattouf

2020

Innovations�(Phila)

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The endpoint in emergent management of acute massive pulmonary embolism (PE) has traditionally been with embolectomy through standard median sternotomy. This approach is limited in both exposure and concomitant functional morbidity associated with sternotomy. Herein we describe a novel minimally invasive, thoracoscopically assisted approach to pulmonary embolectomy. This utilizes a small 5-cm left parasternal thoracotomy and femoral cardiopulmonary bypass to conduct thoracoscopically assisted surgical pulmonary embolectomy. This novel minimally invasive approach has been developed and successfully utilized in 3 patients with massive PE at our institution. The assistance of the thoracoscope allowed for complete visualization and clot extraction of the main and segmental pulmonary arteries bilaterally. The use of a non-sternotomy approach sped both functional and pulmonary recovery times and decreased length of stay. These initial data suggest that non-sternotomy minimally invasive surgical pulmonary embolectomy with thoracoscopic assistance is a feasible and safe approach for acute massive PE that may result in enhanced recovery times and decreased hospital length of stay.

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“…However, there are no current guidelines for management of PE in PFO patients. Surgical embolectomy has been available for decades for patients in this population who have high-risk PE with contraindications to systemic thrombolysis and has been associated with significant decrease in risk of death and embolization compared to those treated with systemic or catheterdirected thrombolysis (Poterucha et al, 2015). Generally speaking, CDT is favored in poor surgical candidates presenting with hemodynamic instability.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy for pulmonary embolism in patients with patent foramen Ovale

et al. 2020

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Background The current level of evidence for mechanical thrombectomy (MT) of pulmonary embolism (PE) in patients with patent foramen ovale (PFO) is limited. Results This was a retrospective analysis of 9 patients with PFO and acute high-risk or intermediate-high-risk PE, 6 with intermediate-high risk and 3 with high-risk PE. All underwent MT using the Inari FlowTriever System from Dec 2018 to November 2019. Six of these patients had confirmed deep venous thrombosis. The technical and clinical success rate for MT in all patients was 100% and 77.8%, respectively. Right-heart strain improved in 6/8 patients on follow-up echocardiography. Mean main pulmonary artery (MPA) pressure significantly decreased after MT (p < 0.012). One patient presented with altered mental status (somnolence and disorientation) prior to coronary artery angiogram and thrombectomy, developed a middle cerebral artery embolic stroke 1 day after MT, and recovered with minor sequalae and later was discharged. There was no in-hospital mortality. Conclusions MT using FlowTriever was feasible and safe, successfully improving MPA pressure in patients presenting with concurrent PFO and PE.

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Surgical Pulmonary Embolectomy

Cited by 20 publications

References 22 publications

Surgical Management of Acute Pulmonary Thromboembolism: our Experience

Surgical Management of Acute Pulmonary Thromboembolism: our Experience

Initial Experience with Non-Sternotomy Minimally Invasive Pulmonary Embolectomy with Thoracoscopic Assistance

Mechanical thrombectomy for pulmonary embolism in patients with patent foramen Ovale

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