Improved outcome of surgical pulmonary embolectomy by aggressive intervention for critically ill patients.

ABSTRACT

BACKGROUND: Acute massive pulmonary thromboembolism is a life-threatening disorder, and prompt treatment is necessary. We analyzed the outcome of pulmonary embolectomy for massive pulmonary embolism. METHODS: Nineteen patients who underwent pulmonary embolectomy were retrospectively investigated. Average age of patients was 59 years, and 79% were female. Most patients had massive or submassive pulmonary thromboemboli dislodging into the main pulmonary trunk or bilateral main pulmonary arteries. Hemodynamics of most patients were unstable. Two patients required percutaneous cardiopulmonary support before embolectomy, and 4 required cardiopulmonary resuscitation. In 6 patients, thrombolysis was ineffective. RESULTS: All patients underwent emergent pulmonary embolectomy. Operative mortality was 5.3%. No patients exhibited newly developed neurologic damage. Ten-year survival rate was 83.5% ± 8.7%. CONCLUSIONS: Pulmonary embolectomy saves critically ill patients having acute massive pulmonary thromboembolism. We must evaluate pulmonary embolism patients with an algorithm that includes surgical embolectomy as one of several therapeutic options.