Acute surgical pulmonary embolectomy: a 9-year retrospective analysis.

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.

Our experience with two cardioplegic solutions: dextrose versus non-dextrose in adult cardiac surgery.

Intraoperative hyperglycemia has been observed to be associated with increased morbidity and mortality after cardiac surgery. Dextrose cardioplegia is used for its cardioprotective effects but may lead to intraoperative hyperglycemia and more postoperative complications. This was a retrospective observational study. Patient records (n = 2301) were accessed from a large database at a tertiary care facility. The two groups (dextrose vs. nondextrose) were then matched using preoperative variables of age, sex, body mass index, wound exposure time, preoperative HbA1c levels, renal failure, hypertension, and prior cerebrovascular disease. The following outcomes were recorded: 30-day mortality, sternal wound infection, stroke, and highest glucose level on cardiopulmonary bypass. The dextrose cardioplegia group showed statistically higher intraoperative glucose levels (272.76 +/- 55.92 vs. 182.79 +/- 45, p value = .0001). There was no difference in postoperative mortality, sternal wound infections or stroke incidence, nor in other secondary outcomes. The type of cardioplegia solution was shown to affect glucose levels; however, there was no effect on postoperative complication rates.