Objective: Massive pulmonary embolism is a life-threatening condition. Currently, surgical pulmonary embolectomy is indicated only for clinically unstable patients or in patients with contraindications or failed thrombolysis. This study reviews the outcome of surgical pulmonary embolectomy in our Institute.
Methods: Patients, who underwent pulmonary embolectomy between December 2007 and June 2014 were retrospectively studied. Operative strategy was either with or without aortic cross-clamping (depending on the existence of a patent foramen ovale and the surgeon`s preference).
Results: A total of 25 pulmonary embolectomies were performed. All patients were in extremis and were severely hemodynamically compromised preoperatively. Aortic cross clamping was utilized in 17 (68%) patients. The usage of aortic cross-clamping was not found to be associated with mortality. Eight (32%) patients were operated after sustained periods of resuscitation preceding the surgery; of these, 5 (20% of the total cohort) died in the immediate postoperative period, while 3 (12% of the total cohort) survived to discharge. Another 2 (8%) high-risk patients died in the immediate postoperative period. In total, 18 (72%) patients survived to discharge; 13 (52%) patients were discharged home, and 5 (20%) were discharged to rehabilitation centers. Fourteen (56%) patients are alive during the writing of this report.
Conclusions: The results of emergent pulmonary embolectomy are encouraging even when performed on patients under CPR. In our series, about 75% of patients could be salvaged and discharged from hospital. Early cardiopulmonary bypass is a vital component in the treatment of these critically ill patients.
