Original Article| Volume 25, ISSUE 12, P1240-1244, December 2016

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Surgical Pulmonary Embolectomy: Experience in a Series of 37 Consecutive Cases


      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.


      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.


      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.


      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.


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        • Aymard T.
        • Kadner A.
        • Widmer A.
        • Basciani R.
        • Tevaearai H.
        • Weber A.
        • et al.
        Massive pulmonary embolism: surgical embolectomy versus thrombolytic therapy--should surgical indications be revisited?.
        Eur J Cardiothorac Surg. 2012; 43: 90-94
        • Takahashi H.
        • Okada K.
        • Matsumori M.
        • Kano H.
        • Kitagawa A.
        • Okita Y.
        Aggressive Surgical Treatment of Acute Pulmonary Embolism With Circulatory Collapse.
        Ann Thorac Surg. 2012; 94: 785-791
        • Greelish J.P.
        • Leacche M.
        • Solenkova N.S.
        • Ahmad R.M.
        • Byrne J.G.
        Improved midterm outcomes for type A (central) pulmonary emboli treated surgically.
        The Journal of Thoracic and Cardiovascular Surgery. 2011; 142: 1423-1429
        • Leacche M.
        • Unic D.
        • Goldhaber S.Z.
        • Rawn J.D.
        • Aranki S.F.
        • Couper G.S.
        • et al.
        Modern surgical treatment of massive pulmonary embolism: Results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach.
        The Journal of Thoracic and Cardiovascular Surgery. 2005; 129: 1018-1023
        • Rudski L.G.
        • Lai W.W.
        • Afilalo J.
        • Hua L.
        • Handschumacher M.D.
        • Chandrasekaran K.
        • et al.
        Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.
        J Am Soc Echocardiogr. 2010; 23 (685-713–quiz786-8)
        • Kucher N.
        • Rossi E.
        • De Rosa M.
        • Goldhaber S.Z.
        Massive pulmonary embolism.
        Circulation. 2006; 113: 577-582
        • Meyer G.
        • Vicaut E.
        • Danays T.
        • Agnelli G.
        • Becattini C.
        • Beyer-Westendorf J.
        • et al.
        Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism.
        N Engl J Med. 2014; 370: 1402-1411
        • Edelman J.J.
        • Yan T.D.
        • Bannon P.G.
        • Wilson M.K.
        • Vallely M.P.
        Coronary Artery Bypass Grafting With and Without Manipulation of the Ascending Aorta – A Meta-Analysis.
        Heart Lung Circ. 2011; 20: 318-324
        • Edelman J.J.
        • Yan T.D.
        • Vallely M.P.
        Anaortic off-pump coronary artery bypass grafting: The criterion standard for minimization of neurologic injury.
        The Journal of Thoracic and Cardiovascular Surgery. 2012; 143: 251-252
        • Goldhaber S.Z.
        • Visani L.
        • De Rosa M.
        Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER).
        The Lancet. 1999; 353: 1386-1389
        • Kasper W.
        • Konstantinides S.
        • Geibel A.
        • Olschewski M.
        • Heinrich F.
        • Grosser K.D.
        • et al.
        Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry.
        J Am Coll Cardiol. 1997; 30: 1165-1171
        • Kasper W.
        • Konstantinides S.
        • Geibel A.
        • Tiede N.
        • Krause T.
        • Just H.
        Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism.
        Heart. 1997; 77: 346-349
        • Ribeiro A.
        • Lindmarker P.
        • Juhlin-Dannfelt A.
        • Johnsson H.
        • Jorfeldt L.
        Echocardiography Doppler in pulmonary embolism: right ventricular dysfunction as a predictor of mortality rate.
        Am Heart J. 1997; 134: 479-487
        • Konstantinides S.V.
        • Torbicki A.
        • Agnelli G.
        • Danchin N.
        • Fitzmaurice D.
        • Galiè N.
        • et al.
        2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism.
        European Heart Journal. 2014; (pp. 3033–69–3069a–3069k)
        • Kucher N.
        • Boekstegers P.
        • Muller O.J.
        • Kupatt C.
        • Beyer-Westendorf J.
        • Heitzer T.
        • et al.
        Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism.
        Circulation. 2014; 129: 479-486
        • Piazza G.
        • Hohlfelder B.
        • Jaff M.R.
        • Ouriel K.
        • Engelhardt T.C.
        • Sterling K.M.
        • et al.
        A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism.
        JACC Cardiovasc Interv. 2015; 8: 1382-1392