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Surgical Embolectomy for Acute Pulmonary Thromboembolism
Ikuo Fukuda1, Kazuyuki Daitoku1
1Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
Annals of Vascular Diseases
|October 17, 2017
Summary
Surgical pulmonary embolectomy is a life-saving procedure for patients with acute pulmonary thromboembolism. This intervention offers excellent outcomes, with in-hospital mortality below 10% for critically ill individuals.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Acute pulmonary thromboembolism (PTE) is a critical condition, particularly in hospitalized patients, with high mortality rates.
- Prognosis is directly linked to the extent of pulmonary arterial occlusion.
- Massive PTE carries mortality rates of 25% (without) and 65% (with) cardiopulmonary arrest.
Purpose of the Study:
- To evaluate the efficacy and safety of surgical pulmonary embolectomy in managing acute pulmonary thromboembolism.
- To highlight the importance of early triage and a multidisciplinary team approach for critically ill PTE patients.
Main Methods:
- Surgical pulmonary embolectomy is indicated for patients with hemodynamically unstable PTE who have contraindications to thrombolysis, or have failed catheter-based therapy or thrombolysis.
- Considered for patients on extracorporeal membrane oxygenation (ECMO) due to circulatory collapse or cardiopulmonary arrest.
Main Results:
- Prompt removal of pulmonary emboli reduces right ventricular strain, facilitating rapid cardiopulmonary recovery post-surgery.
- Recent series report excellent outcomes with in-hospital mortality rates below 10% for surgical pulmonary embolectomy.
Conclusions:
- Surgical pulmonary embolectomy is an effective, safe, and straightforward procedure for critically ill patients with PTE.
- Early identification and surgical intervention are crucial for improving survival in massive and sub-massive PTE.