Pulmonary embolectomy: recommendation for early surgical intervention.

Area of Science:

• Cardiology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Acute pulmonary embolism (PE) is a critical condition requiring prompt diagnosis and aggressive treatment.
• Current management strategies for severe acute PE lack a definitive consensus.
• Surgical pulmonary embolectomy is a potential intervention for acute PE.

Purpose of the Study:

• To evaluate the outcomes of surgical pulmonary embolectomy in patients with acute severe PE.
• To determine the efficacy of surgical pulmonary embolectomy in hemodynamically stable versus unstable patients.
• To assess the impact of right ventricular dysfunction on surgical pulmonary embolectomy outcomes.

Main Methods:

• A retrospective review of 16 consecutive patients undergoing surgical pulmonary embolectomy between May 2000 and June 2009.
• Patients were categorized as massive PE, with some requiring emergent operation under cardiopulmonary resuscitation.
• Preoperative assessment included evaluation for hemodynamic collapse and right ventricular (RV) dilation/dysfunction.

Main Results:

• Seven in-hospital deaths (43%) occurred among the 16 patients.
• Mortality was significantly lower in emergent operations (11%) compared to salvage operations (85%).
• Patients undergoing non-salvage surgery frequently presented with moderate to severe RV dilation/dysfunction.

Conclusions:

• Surgical pulmonary embolectomy is associated with satisfactory outcomes in hemodynamically stable PE patients with RV dilation/failure.
• Pulmonary embolectomy yields poor results in salvage situations.
• Current guidelines for surgical management of acute severe PE may require revision.