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Pulmonary embolectomy: a 25 year experience.

D B Clarke, L D Abrams

    The Journal of Thoracic and Cardiovascular Surgery
    |September 1, 1986
    PubMed
    Summary
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    Emergency pulmonary embolectomy during circulatory standstill offers high survival rates for patients without cardiac arrest. This technique is a viable option for hospitals without cardiac surgery facilities.

    Area of Science:

    • Cardiovascular Surgery
    • Pulmonary Embolism Management

    Background:

    • Pulmonary embolism is a life-threatening condition requiring prompt intervention.
    • Traditional surgical approaches may be limited by resource availability.

    Purpose of the Study:

    • To evaluate the efficacy and safety of emergency pulmonary embolectomy performed under normothermic circulatory standstill.
    • To assess the feasibility of this technique in hospitals lacking advanced cardiac surgical facilities.

    Main Methods:

    • Retrospective analysis of 55 pulmonary embolectomy procedures performed over 25 years.
    • Procedures utilized normothermic circulatory standstill induced by vena cava clamping.
    • Patient outcomes were stratified based on the occurrence of cardiac arrest (asystole or ventricular fibrillation).

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    Main Results:

    • A 97.2% intraoperative survival rate was observed in patients without cardiac arrest (35/36).
    • Overall postoperative mortality was 20% (7/36) in the no-cardiac-arrest group.
    • Patients experiencing cardiac arrest had a significantly higher mortality rate of 73.7% (14/19 died during or post-operation).

    Conclusions:

    • Emergency pulmonary embolectomy under normothermic circulatory standstill is a successful technique in properly selected patients.
    • The procedure's simplicity allows its application in facilities without cardiac surgical capabilities.
    • Early intervention using this method can mitigate the highest risk period following pulmonary embolism.