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Pulmonary embolectomy: a 20-year experience at one center
1Department of Cardiothoracic Surgery, Laennec Hospital, Paris, France.
The Annals of Thoracic Surgery
|February 1, 1991
Summary
Pulmonary embolectomy for acute massive pulmonary embolism had a 37.5% operative mortality. Cardiac arrest and cardiopulmonary disease predicted death, but long-term results were acceptable for select patients.
Area of Science:
- Cardiology
- Thoracic Surgery
- Critical Care Medicine
Background:
- Acute massive pulmonary embolism is a life-threatening condition.
- Pulmonary embolectomy is a surgical option for selected patients.
- Predictive factors for surgical outcomes require further elucidation.
Purpose of the Study:
- To identify predictors of operative mortality and long-term outcomes following pulmonary embolectomy.
- To evaluate the long-term efficacy of pulmonary embolectomy in patients with acute massive pulmonary embolism.
Main Methods:
- Retrospective analysis of 96 consecutive patients undergoing pulmonary embolectomy between 1968 and 1988.
- Univariate and multivariate analyses of 12 clinical and hemodynamic variables.
- Long-term follow-up of discharged patients for mortality and functional status.
Main Results:
- Operative mortality rate was 37.5%.
- Cardiac arrest and associated cardiopulmonary disease were independent predictors of operative death.
- Among 55 discharged patients with follow-up, 6 died and 5 experienced persistent dyspnea (NYHA class II).
Conclusions:
- Pulmonary embolectomy carries significant operative risk.
- Preoperative cardiac arrest and cardiopulmonary disease are critical risk factors.
- Pulmonary embolectomy can be an acceptable procedure with favorable long-term results for carefully selected patients unresponsive to optimal medical therapy.