Background
Massive pulmonary embolism is a poorly tolerated condition. Treatment options in this
condition include anticoagulation and primary reperfusion therapy – systemic thrombolysis,
catheter based treatments or surgical embolectomy. There is little data on the relative
efficacy of each treatment.
Methods
The preoperative characteristics and outcomes of patients referred for surgical embolectomy
between 2000-2014 was reviewed. Echocardiography was performed in the majority of
patients before and after surgery.
Results
Thirty-seven patients underwent pulmonary embolectomy between 2000-2014. One patient
died within 30 days, another before leaving hospital. All other patients were alive
at the time of follow-up (survival 94.6% at median 36 months). Median ventilation
time was 24 hours. Median hospital length of stay was 10.5 days. There was echocardiographic evidence
of severe right ventricular strain (increased size and decreased function) before
surgery, which was significantly improved to within the normal range by discharge,
and follow-up.
Conclusions
Surgical embolectomy is a safe procedure, with low mortality, improved postoperative
right ventricular function and pulmonary pressure, and good long-term outcome. Early
relief of a large proportion of the clot burden can be life-saving. There should be
consideration for its use as an initial treatment strategy in patients with massive
or submassive pulmonary embolus with a large burden of proximal clot. A multidisciplinary
approach for the treatment of these patients is required.
Keywords
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Article info
Publication history
Published online: May 12, 2016
Accepted:
March 24,
2016
Received in revised form:
March 21,
2016
Received:
December 20,
2015
Identification
Copyright
© 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
