Surgical pulmonary embolectomy: mid-term outcomes

Despite the widespread use of venous thromboembolism (VTE) prophylaxis in hospitalized patients, pulmonary embolism continues to occur. Massive pulmonary embolism is associated with a high mortality. Surgical embolectomy has traditionally been reserved for cases with haemodynamic collapse or where thrombolysis is contraindicated or has failed.

Data on 10 patients who underwent surgical embolectomy (40% male, mean age 49 years (range 25-72)) from January 2003 to February 2010 were prospectively collected and retrospectively analysed.

Diagnosis was made using computed tomography pulmonary angiography in eight patients and echocardiography in two. Syncope was the most common presenting symptom (7 out of 10, 70%) and relative immobilization was the most common risk factor (7 out of 10, 70%). Four patients (40%) suffered preoperative cardiac arrest, with a further two on induction of anaesthesia. Thirty-day mortality was 4 out of 10 (40%), with one late death. Mean follow-up of five survivors was 39 months and included clinic review or telephone interview, SF-36 questionnaire for quality of life, transthoracic echocardiography for right ventricular (RV) function and respiratory function testing. All survivors received an inferior vena cava filter and 6 months of anticoagulation with no cases of recurrent thromboembolism. RV systolic dysfunction was severe in all cases prior to surgery, but improved to near normal at follow-up.

Survivors had good quality of life, were functionally NYHA class I-II with normal respiratory function.