RESUMO
Acute pulmonary embolism is a substantial cause of morbidity and death. Although the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines recommend surgical pulmonary embolectomy in patients with acute pulmonary embolism associated with hypotension, there are few reports of 30-day mortality rates. We performed a retrospective review of acute pulmonary embolectomy procedures performed in 96 consecutive patients who had severe, globally hypokinetic right ventricular dysfunction as determined by transthoracic echocardiography. Data on patients who were treated from January 2003 through December 2011 were derived from health system databases of the New York State Cardiac Surgery Reporting System and the Society of Thoracic Surgeons. The data represent procedures performed at 3 tertiary care facilities within a large health system operating in the New York City metropolitan area. The overall 30-day mortality rate was 4.2%. Most patients (68 [73.9%]) were discharged home or to rehabilitation facilities (23 [25%]). Hemodynamically stable patients with severe, globally hypokinetic right ventricular dysfunction had a 30-day mortality rate of 1.4%, with a postoperative mean length of stay of 9.1 days. Comparable findings for hemodynamically unstable patients were 12.5% and 13.4 days, respectively. Acute pulmonary embolectomy can be a viable procedure for patients with severe, globally hypokinetic right ventricular dysfunction, with or without hemodynamic compromise; however, caution is warranted. Our outcomes might be dependent upon institutional capability, experience, surgical ability, and careful patient selection.
Assuntos
Embolectomia , Artéria Pulmonar/cirurgia , Embolia Pulmonar/cirurgia , Disfunção Ventricular Direita/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolectomia/efeitos adversos , Embolectomia/mortalidade , Feminino , Hemodinâmica , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Artéria Pulmonar/fisiopatologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Embolia Pulmonar/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/mortalidade , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular DireitaRESUMO
Patients with abdominal aortic aneurysms (AAAs) often have concomitant coronary artery disease. In patients with large or symptomatic AAAs and symptomatic coronary artery disease, it may be necessary to address both problems simultaneously. We report a case series of five patients undergoing simultaneous off-pump coronary artery bypass and abdominal aortic reconstruction. Our series and a literature review indicate that simultaneous coronary artery bypass grafting on the beating heart and abdominal aortic surgery is safe and effective and has a low perioperative morbidity rate.