Outcomes of Surgical Pulmonary Embolectomy for Acute Pulmonary Embolism: A 14-Year Single-Centre Study

This retrospective single-centre cohort study investigates the outcomes of surgical pulmonary embolectomy for high-risk acute pulmonary embolism (PE) at our institution over a 14-year period.

We conducted a retrospective review of medical records for 13 consecutive patients who underwent surgical pulmonary embolectomy (SPE) between 2006 and 2020. Data collected included patient demographics, comorbidities, pre-operative assessments (echocardiography, computed tomography pulmonary angiography (CTPA) findings), indications for SPE, surgical details, post-operative complications, and 12-month survival.

The study cohort comprised 13 patients, predominantly male (69.2%), with a median age of 47 years. Comorbidities varied, with one patient lacking identifiable risk factors. Pre-operative assessment demonstrated right ventricular dysfunction identified on echocardiography, CTPA, or both modalities. Indications for SPE included high-risk PE (76.9%), contraindication to thrombolysis (7.7%), and persistent haemodynamic instability despite thrombolysis (15.4%). All procedures were performed via median sternotomy with cardiopulmonary bypass. The median ICU stay was two days. In-hospital mortality was 23.1%. Post-operative complications included atrial fibrillation (30.8%), cardiac tamponade (15.4%), and residual PE (23.1%). Twelve-month survival was 76.9%.

Our 14-year experience demonstrates that SPE remains a viable and critical intervention for select high-risk PE patients, particularly in a specialised tertiary care setting. Despite the critical nature of the patient population, the observed outcomes align with contemporary reports, suggesting improved survival with timely and expert care.