Pulmonary embolectomy for acute massive pulmonary embolism

Acute massive pulmonary embolism usually results in death if not diagnosed early and treated aggressively. Thrombolytic therapy and catheter embolectomy are increasingly used as definitive management. Emergent open embolectomy is often reserved as a last resort when less invasive methods have failed or the patient is in cardiopulmonary arrest.

We reviewed our experience with early open pulmonary embolectomy in patients with acute massive pulmonary embolism from January 1998 to February 2004.

Eleven patients underwent early pulmonary embolectomy. Five (45%) patients were men, and the average age was 48 years. In 4 (36%) patients, a massive pulmonary embolism occurred after a surgical procedure or trauma. The remaining 7 patients had chronic medical diseases. The diagnosis was established primarily by clinical findings along with spiral computerized tomography or transesophageal echocardiography. Eight (73%) patients survived and were discharged from the hospital. The 3 patients who died suffered cardiac arrest preoperatively and were taken to the operating room with cardiopulmonary resuscitation in progress. Only 1 patient survived after preoperative cardiac arrest.

Early open pulmonary embolectomy using cardiopulmonary bypass is an effective form of treatment for acute massive pulmonary embolism with excellent long-term results. Preoperative cardiac arrest is associated with a high mortality. Spiral computerized tomography and transesophageal echocardiography are important diagnostic tools.