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Prehospital Thrombolysis: A Manual from Berlin
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Simple and secure thrombectomy without circulatory arrest for acute pulmonary embolism
Hanae Sasaki1, Ryosuke Kowatari2, Norihiro Kondo1
1Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki City, Aomori, 036-8562, Japan.
Journal of Cardiothoracic Surgery
|February 8, 2024
Summary
A new surgical technique simplifies pulmonary artery thrombectomy for massive pulmonary embolism (PE) when other treatments fail. This method improves visualization for peripheral thrombus removal, aiding recovery.
Area of Science:
- Cardiovascular Surgery
- Pulmonary Embolism Treatment
- Surgical Innovation
Background:
- Massive pulmonary embolism (PE) necessitates emergency treatment when fibrinolysis is ineffective.
- Peripheral pulmonary artery thrombus removal presents surgical challenges.
- Established surgical pulmonary artery thrombectomy requires a secure method for complex cases.
Observation:
- A novel surgical pulmonary artery thrombectomy technique was developed.
- The method utilizes cardiopulmonary bypass and cardiac arrest for a stable surgical field.
- A surgical assistant arm, typically for coronary artery bypass grafting, was adapted to create a working space.
Findings:
- Seven consecutive massive PE patients underwent the procedure.
- All patients were successfully weaned from cardiopulmonary bypass or ECMO postoperatively.
- The technique allows clear visualization for thrombus removal up to the second pulmonary artery branch.
Implications:
- This approach enhances the safety and efficacy of surgical PE treatment.
- It can prevent postoperative right ventricular failure by enabling thorough thrombus clearance.
- The method offers a secure and feasible option for complex peripheral pulmonary artery thrombectomy.
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