Excellent outcome after surgical treatment of massive pulmonary embolism in critically ill patients

Kadner, Alexander; Schmidli, Jürg; Schönhoff, Florian; Krähenbühl, Eva; Immer, Franz; Carrel, Thierry; Eckstein, Friedrich (2008). Excellent outcome after surgical treatment of massive pulmonary embolism in critically ill patients. Journal of thoracic and cardiovascular surgery, 136(2), pp. 448-51. St. Louis, Mo.: Mosby 10.1016/j.jtcvs.2007.11.021

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OBJECTIVE: Treatment of central and paracentral pulmonary embolism in patients with hemodynamic compromise remains a subject of debate, and no consensus exists regarding the best method: thrombolytic agents, catheter-based thrombus aspiration or fragmentation, or surgical embolectomy. We reviewed our experience with emergency surgical pulmonary embolectomy. METHODS: Between January of 2000 and March of 2007, 25 patients (17 male, mean age 60 years) underwent emergency open embolectomy for central and paracentral pulmonary embolism. Eighteen patients presented in cardiogenic shock, 8 of whom had cardiac arrest and required cardiopulmonary resuscitation. All patients underwent operation with mild hypothermic cardiopulmonary bypass. Concomitant procedures were performed in 8 patients (3 coronary artery bypass grafts, 2 patent foramen ovale closures, 4 ligations of the left atrial appendage, 3 removals of a right atrial thrombus). Follow-up is 96% complete with a median of 2 years (range, 2 months to 6 years). RESULTS: All patients survived the procedure, but 2 patients died in the hospital on postoperative days 1 (intracerebral bleeding) and 11 (multiorgan failure), accounting for a 30-day mortality of 8% (95% confidence interval: 0.98-0.26). Four patients died later because of their underlying disease. Pre- and postoperative echocardiographic pressure measurements demonstrated the reduction of the pulmonary hypertension to half of the systemic pressure values or less. CONCLUSION: Surgical pulmonary embolectomy is an excellent option for patients with major pulmonary embolism and can be performed with minimal mortality and morbidity. Even patients who present with cardiac arrest and require preoperative cardiopulmonary resuscitation show satisfying results. Immediate surgical desobstruction favorably influences the pulmonary pressure and the recovery of right ventricular function, and remains the treatment of choice for patients with massive central and paracentral embolism with hemodynamic and respiratory compromise.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Heart Surgery
UniBE Contributor:	Kadner, Alexander, Schmidli, Jürg, Schönhoff, Florian, Roost, Eva, Immer, Franz Ferdinand, Carrel, Thierry, Eckstein, Friedrich Stefan
ISSN:	0022-5223
ISBN:	18692656
Publisher:	Mosby
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 15:05
Last Modified:	27 Feb 2024 14:29
Publisher DOI:	10.1016/j.jtcvs.2007.11.021
PubMed ID:	18692656
Web of Science ID:	000258535300030
URI:	https://boris.unibe.ch/id/eprint/28283 (FactScience: 119542)