Acute massive pulmonary embolism (APE) resulting in hemodynamic instability is a fatal condition. Pulmonary embolectomy serves as definitive therapy for those in whom catheter embolectomy and thrombolysis are either contraindicated or unsuccessful.
This study was performed to determine our experience with pulmonary embolectomy for APE. We performed a retrospective chart review of patients undergoing pulmonary embolectomy for APE from October 1994 to August 2003. Charts provided demography, symptomatology, operative procedures, and short term outcomes.
A total of 13 patients underwent pulmonary embolectomy between October 1994 and August 2003. Average age was 52 years (range 32 to 65). Symptoms were present in all patients and 63% of patients had hemodynamic instability at the time of operation. Diagnosis was established by either spiral computerized tomography or transesophageal echocardiography. Emergent surgery was undertaken in 70% of patients. Cardiopulmonary bypass was established in all patients with 30% requiring circulatory arrest. Overall survival was 63%. When comparing survivors to non-survivors, the latter group was more likely to be operated on emergently. Of those who survived, all are well at a mean follow-up of 12.3 months.
Pulmonary embolectomy utilizing cardiopulmonary bypass and circulatory arrest is effective treatment in patients with massive embolism and is associated with good short term outcomes. Operative mortality is increased when surgery is performed under emergent conditions.
Pulmonary embolectomy for acute massive pulmonary embolism serves as definitive therapy and should be utilized in patients refractory to other therapeutic modalities.
A Salemi, None.