Cardiothoracic Surgery |

Improved Outcome of Surgical Pulmonary Embolectomy in a Referral Hospital Setting FREE TO VIEW

David No*, MS; Christine No, MS; Kevin Casey, MD; Gerald Tracy, MD
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The Commonwealth Medical College, Scranton, PA

Chest. 2012;142(4_MeetingAbstracts):63A. doi:10.1378/chest.1380697
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SESSION TYPE: Thoracic Surgery Posters I

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Acute massive pulmonary embolism is a rare life-threatening condition. There is no consensus regarding the best method for prompt treatment, which includes heparin, thrombolytic agents, catheter-based embolectomy, or surgical embolectomy. This study retrospectively reviews emergency surgical pulmonary embolectomy in a referral hospital setting.

METHODS: Between November of 2008 and October of 2011, 7 patients (4 male, age range 30-72 years) underwent emergency surgical embolectomy for massive pulmonary embolism. The indications for surgical intervention were (1) contraindication to thrombolysis (4/7 [57.1%]) and (2) right ventricular dysfunction (2/7 [28.6%]). Preoperatively, 2 patients were in cardiogenic shock and 1 patient in cardiac arrest. All patients underwent operations with hypothermic arrest cardiopulmonary bypass.

RESULTS: There were no operative deaths, but 2 patients died in the hospital on postoperative days 9 and 20, one patient had preoperative cardiac arrest and the other patient had preoperative cardiogenic shock. One late death occurred because of an underlying metastatic cancer. Pre and postoperative echocardiographic pressure measurements demonstrated the reduction of the pulmonary hypertension to half of the pre-surgical pressure values or less.

CONCLUSIONS: The results of emergent pulmonary embolectomy are encouraging particularly among patients without cardiogenic shock or arrest. A surgical approach is an excellent option for patient with massive pulmonary embolism and outcomes show minimal mortality and morbidity. Immediate surgical approach also quickly decreases the right ventricular after load and improves right ventricular function by reducing the pulmonary pressure by more than half.

CLINICAL IMPLICATIONS: It should be noted that surgical embolectomy should not be reserved as a last resort option. Rather, a surgical approach should be considered in patients with right ventricular dysfunction that is an early sign of impending hemodynamic collapse. These patients are best managed with a multispecialty approach including pulmonary, cardiology, and cardio-thoracic surgical specialists. Emergent risk stratification with CT angiogram, bio-markers, and ECHO can result in improved pulmonary patent vasculature, improved right heart function, and improved patient survival.

DISCLOSURE: The following authors have nothing to disclose: David No, Christine No, Kevin Casey, Gerald Tracy

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The Commonwealth Medical College, Scranton, PA




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