Abstract
Pulmonary embolectomy is one of the oldest cardiac operations, dating back to the early 20th century. Initially performed blindly as a closed cardiac procedure, the operation is now performed on cardiopulmonary bypass with clots extracted from the opened pulmonary arteries under direct vision. Surgery was the mainstay of therapy for pulmonary emboli in the 1960s and 1970s. Presently, however, with the advent of effective nonsurgical therapy, pulmonary embolectomy is largely reserved for anatomically extensive central emboli with hemodynamic compromise or right ventricular strain, or for cases in which medical therapy has failed or is contraindicated. The results of surgery have improved greatly in recent years, with contemporary series reporting mortality rates below 10%. Patient selection and surgical management are the key to minimizing the mortality of this operation. If patients are operated on at an early stage, before the onset of irreversible right ventricular dysfunction or protracted cardiogenic shock, then the mortality risk is low. On the other hand, preoperative cardiac arrest leads to a fivefold increase in mortality. Modern intraoperative management includes cardiopulmonary bypass, avoidance of cardiac ischemia, extraction of clots under direct vision only, and placement of cava filters. Some patients are not suitable for pulmonary embolectomy, including those undergoing cardiopulmonary resuscitation, those with predominantly peripheral emboli, and patients who do not have immediate access to cardiac surgery (thrombolysis is preferable to a delay in treatment). On the other hand, in centers with the infrastructure for immediate embolectomy, surgery offers the fastest means of deobliterating the pulmonary arteries and should thus be considered as a therapeutic option in all patients with massive or even submassive pulmonary embolism.
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References
Trendelenburg F. Über die operative Behandlung der Embolite der Lungarterie. Arch Klin Chir 1908;86:686–700.
Steenburg RW, Warren R, Wilson RE, Rudolf LE. A new look at pulmonary embolectomy. Surg Gynecol Obstet 1958;107(2):214–220.
Westaby S. The foundations of cardiac surgery. In: Westaby S, ed. Landmarks in Cardiac Surgery. Isis Medical Media, Oxford, 1997, pp. 1–47.
Sharp EH. Pulmonary embolectomy: successful removal of a massive pulmonary embolus with the support of cardiopulmonary bypass. Case report. Ann Surg 1962;156:1–4.
Bennett JG. Pulmonary embolectomy after “death”. Cardiovasc Dis 1976;3(3):334–339.
Clarke DB, Abrams LD. Pulmonary embolectomy with venous inflow-occlusion. Lancet 1972;1(7754):767–769.
Stulz P, Schlapfer R, Feer R, Habicht J, Gradel E. Decision making in the surgical treatment of massive pulmonary embolism. Eur J Cardiothorac Surg 1994;8(4):188–193.
Keogh BE, Kinsman R. Fifth National Adult Cardiac Surgical Database Report 2003. Henley-on-Thames, Dendrite, 2004.
Aklog L. Emergency surgical pulmonary embolectomy. Semin Vasc Med 2001;1(2):235–246.
Aklog L, Williams CS, Byrne JG, Goldhaber SZ. Acute pulmonary embolectomy: a contemporary approach. Circulation 2002;105(12):1416–1419.
Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 2000;101(24):2817–2822.
Sukhija R, Aronow WS, Lee J, et al. Association of right ventricular dysfunction with in-hospital mortality in patients with acute pulmonary embolism and reduction in mortality in patients with right ventricular dysfunction by pulmonary embolectomy. Am J Cardiol 2005;95(5):695–696.
Leacche M, Unic D, Goldhaber SZ, et al. Modern surgical treatment of massive pulmonary embolism: results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach. J Thorac Cardiovasc Surg 2005;129(5):1018–1023.
Dauphine C, Omari B. Pulmonary embolectomy for acute massive pulmonary embolism. Ann Thorac Surg 2005;79(4):1240–1244.
Yalamanchili K, Fleisher AG, Lehrman SG, et al. Open pulmonary embolectomy for treatment of major pulmonary embolism. Ann Thorac Surg 2004;77(3):819–823.
Ohteki H, Norita H, Sakai M, Narita Y. Emergency pulmonary embolectomy with percutaneous cardiopulmonary bypass. Ann Thorac Surg 1997;63(6):1584–1586.
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© 2007 Humana Press Inc., Totowa, NJ
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Anyanwu, A.C., Aklog, L. (2007). Surgical Pulmonary Embolectomy. In: Konstantinides, S.V. (eds) Management of Acute Pulmonary Embolism. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-287-8_12
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DOI: https://doi.org/10.1007/978-1-59745-287-8_12
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