Survival and recurrence after acute pulmonary embolism treated with pulmonary embolectomy or thrombolysis in New York State, 1999 to 2013

Lee, Timothy J.; Itagaki, Shinobu; Chiang, Yu-Ting; Egorova, Natalia; Adams, David H.; Chikwe, Joanna

doi:10.1016/j.jtcvs.2017.07.074

Cited by 80 publications

(59 citation statements)

References 22 publications

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“…Surgical embolectomy in acute PE is usually carried out with cardiopulmonary bypass, without aortic cross-clamping and cardioplegic cardiac arrest, followed by incision of the two main pulmonary arteries with the removal or suction of fresh clots. Recent reports have indicated favourable surgical results in high-risk PE, with or without cardiac arrest, and in selected cases of intermediate-risk PE [297][298][299][300]. Among 174 322 patients hospitalized between 1999 and 2013 with a diagnosis of PE in New York state, survival and recurrence rates were compared between patients who underwent thrombolysis (n=1854) or surgical embolectomy (n=257) as first-line therapy [297].…”

Section: Surgical Embolectomymentioning

confidence: 99%

“…Recent reports have indicated favourable surgical results in high-risk PE, with or without cardiac arrest, and in selected cases of intermediate-risk PE [297][298][299][300]. Among 174 322 patients hospitalized between 1999 and 2013 with a diagnosis of PE in New York state, survival and recurrence rates were compared between patients who underwent thrombolysis (n=1854) or surgical embolectomy (n=257) as first-line therapy [297]. Overall, there was no difference between the two types of reperfusion treatment regarding 30 day mortality (15 and 13%, respectively), but thrombolysis was associated with a higher risk of stroke and re-intervention at 30 days.…”

Section: Surgical Embolectomymentioning

confidence: 99%

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2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

et al. 2019

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Section: Surgical Embolectomymentioning

confidence: 99%

Section: Surgical Embolectomymentioning

confidence: 99%

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

et al. 2019

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“…As we previously wrote, recent reports highlighting improved surgical techniques have shown that surgical pulmonary embolectomy yields similar 30-day and 5-year mortality rates compared to thrombolytic therapy. 5,6 However, compared to thrombolysis, surgical pulmonary embolectomy was associated with lower rates of bleeding complications, stroke, and requirement for re-intervention within 30 days. 6 Our introduction of the MIPE via a left mini thoracotomy highlights an advancement in surgical embolectomy in that it avoids sternotomy and related complications allowing for enhanced recovery.…”

Section: Discussionmentioning

confidence: 99%

Lessons learned on a new procedure: Non-Sternotomy Minimally Invasive Pulmonary Embolectomy

Laan

Assaf

Lattouf

2020

Preprint

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Since publication of our initial experience with non-sternotomy minimally invasive pulmonary embolectomy (MIPE) via a left mini thoracotomy, we have expanded our experience, refined the operation and streamlined the post-operative management of patients. Our initial publication described three patients who underwent MIPE.1 We described our technique which included peripheral cardiopulmonary bypass (CPB) via femoral arterial and venous cannulation, left sided 5cm anterior thoracotomy in the 3rd intercostal space, identification and incision of the main pulmonary artery distal to the pulmonic valve, extraction of clot with subsequent primary closure of the pulmonary artery, and use of a 5mm, 30 degree laparoscope as an adjunct to assess clearance of the pulmonary artery.2 The patients included in this series had no post-operative complications, had a mean hospital length of stay of three days with mid-term follow-up up to 8-months revealing no untoward complications of the procedure. With early success of the MIPE at our institution, we began employing it preferentially over sternotomy with central CPB and pulmonary embolectomy. Since initial publication of our results, we have performed the MIPE in two additional patients with excellent outcomes. We herein present augmentations we've made to the procedure with a case-presentation which highlights these adaptations.

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“…Therefore, cardioplegic cardiac arrest with cardiopulmonary bypass is usually necessary. In comparison to systemic thrombolysis, Lee et al reported similar survival rates and a lower risk of stroke [14]. However, surgical embolectomy showed the highest mortality rates (32%) after cardiac arrest [15].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Accelerated Thrombolysis in High-Risk Perioperative Pulmonary Embolism: Two Case Reports and Review of Literature

Schmidt

Edinger

Koch

et al. 2020

Preprint

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Background: Treatment of high-risk pulmonary embolism (PE) in perioperative patients remains challenging. Systemic thrombolysis is associated with a high risk of major bleedings and intracranial haemorrhage. High mortality rates are reported for open pulmonary embolectomy. Therefore, postoperative surgical patients may benefit substantially from catheter-directed ultrasound-accelerated thrombolysis (USAT).Case summary: We report two cases of high-risk perioperative PE. Both patients developed severe haemodynamic instability leading to cardiac arrest. After the implantation of a veno-arterial extracorporeal membrane oxygenation (ECMO), they were both successfully treated with USAT. Adequate improvement of right ventricular function was achieved; thus, ECMO could be successfully weaned after three and four days, respectively. Both patients showed favourable outcomes and could be discharged to rehabilitation. Discussion: The current European guideline on treatment of PE offers no specific therapies for perioperative patients with high-risk PE. However, systemic thrombolysis is often excluded due to the perioperative setting and the risk of major bleeding. Catheter-directed thrombolysis was shown to utilise less thrombolytic agent while obtaining comparable thrombolytic effects. The risk for major bleeding (including intracranial haemorrhage) is also significantly lowered. Conclusion: Further prospective randomised controlled trials are necessary to determine the value of USAT treatment of high-risk PE in perioperative patients.

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Survival and recurrence after acute pulmonary embolism treated with pulmonary embolectomy or thrombolysis in New York State, 1999 to 2013

Abstract: Pulmonary embolectomy and thrombolysis are associated with similar early and long-term survival, supporting guideline recommendations for embolectomy when thrombolysis is contraindicated.

Cited by 80 publications

References 22 publications

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

Lessons learned on a new procedure: Non-Sternotomy Minimally Invasive Pulmonary Embolectomy

Ultrasound-Accelerated Thrombolysis in High-Risk Perioperative Pulmonary Embolism: Two Case Reports and Review of Literature

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