| A more aggressive approach to emergency embolectomy for acute pulmonary embolism. | |
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MedLine Citation:
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PMID: 20810792 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To examine operative outcomes after acute pulmonary embolectomy (APE), a recently adopted, more aggressive surgical approach. PATIENTS AND METHODS: We retrospectively identified patients who underwent surgical APE from April 1, 2001, through March 31, 2009, and reviewed their clinical records for perioperative outcome. Operations were performed with normothermic cardiopulmonary bypass and a beating heart, absent a patent foramen ovale. For completeness, embolectomy was performed via separate incisions in the left and right pulmonary arteries (PAs) in 15 patients. RESULTS: Of the 18 patients identified, the mean age was 60 years, and 13 patients (72%) were men. Thirteen patients (72%) had been hospitalized recently or had systemic disease. The preoperative diagnosis was established by echocardiography or computed tomography (or both). The median (range) follow-up time for all surviving patients was 16 months (2-74 months). Indications for APE included cardiogenic shock (n=12; 67%) and severe right ventricular dysfunction as shown by echocardiography (n=5; 28%). Seven patients (39%) had an embolus in transit. Seven patients (39%) experienced cardiopulmonary arrest before APE. Four early deaths (22%) occurred; all 4 of these patients had preoperative cardiopulmonary arrest, and 2 had APE via the main PA only, without branch PA incisions. Two late deaths (11%) occurred. Right ventricular function improved in all survivors. CONCLUSION: The results of emergent APE are encouraging, particularly among patients without cardiopulmonary arrest. It should not be reserved for patients in extremis; rather, it should be considered for patients with right ventricular dysfunction that is an early sign of impending hemodynamic collapse. |
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Authors:
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Basar Sareyyupoglu; Kevin L Greason; Rakesh M Suri; Mark T Keegan; Joseph A Dearani; Thoralf M Sundt |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Mayo Clinic proceedings. Mayo Clinic Volume: 85 ISSN: 1942-5546 ISO Abbreviation: Mayo Clin. Proc. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-09-02 Completed Date: 2010-09-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0405543 Medline TA: Mayo Clin Proc Country: United States |
Other Details:
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Languages: eng Pagination: 785-90 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Echocardiography Embolectomy / methods*, mortality Emergencies Female Heart Arrest / etiology Humans Male Middle Aged Pulmonary Artery / surgery Pulmonary Embolism / complications, mortality, surgery* Retrospective Studies Shock, Cardiogenic / etiology Survival Rate Tomography, X-Ray Computed Treatment Outcome Ventricular Dysfunction, Right / etiology |
| Comments/Corrections | |
Comment In:
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Mayo Clin Proc. 2010 Sep;85(9):782-4
[PMID:
20810791
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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