Acute pulmonary embolism: a current surgical approach

Abstract

Acute massive pulmonary embolism has a high mortality rate despite advances in diagnosis and therapy. Thrombolysis and catheter embolectomy have recently shown various degrees of failure and adverse effect. Surgical embolectomy has now been liberalised for haemodynamic stable patients with right ventricular dysfunction. We report our surgical experience in the last ten years including massive and sub-massive pulmonary embolism. A retrospective review of charts of all patients undergoing pulmonary embolectomy at our institution over the last ten years was performed. Patients were followed up until December 2005, end point of our study. Between March 1995 and December 2005, 21 patients underwent pulmonary embolectomy. Fourteen patients had a massive pulmonary embolism and were in cardiogenic shock (group A). Seven patients had a sub-massive embolism and were haemodynamically stable with right ventricular dysfunction (group B). In group A, 43% of patients survived and were discharged from the hospital. In group B, all the patients survived and were discharged from the hospital. After a follow-up of 57±12 months no late death linked to pulmonary embolism was observed. Our approach by initial surgical embolectomy improved outcome in sub-massive PE. Rescue embolectomy for very compromised patients remains a current treatment for massive PE. Furthermore, surgical embolectomy in haemodynamically stable patients is an immediate and definitive treatment for PE, with excellent long-term results. Keeping in mind that thrombolysis and catheter embolectomy have varying degrees of failure and risk, we propose surgical embolectomy in (sub)massive pulmonary embolism as an alternative procedure, or even as a primary treatment.