Pulmonary embolectomy (answered and unanswered questions)

Pulmonary embolectomy under total cardiopulmonary bypass was carried out in 16 patients with cardiogenic collapsus and hypotension not responding to vasopressors or cardiac arrest. Eleven patients (68.75%) survived and were followed up for years. Our observations are presented with special emphasis on the early and accurate diagnosis, the exact timing of the therapeutic methods, the use of the portable cardiopulmonary bypass-even in the ward, and the possibilities of decreasing the operative mortality rate in less than 30% (from 40% to 22% in our series). Despite the fact that in many countries, especially European, pulmonary artery embolectomy is no more carried out as a primary therapy for massive or submassive embolism since thrombolysis is today considered as the best therapy with a low mortality rate of 8-11%, we still believe that there is a number of patients who could benefit only from surgical intervention. Based on our own experience and that presented in the international literature, an attempt was made to discuss the existing problems, mainly diagnosis and treatment of this formidable condition, reevaluating pulmonary embolectomy.