Short- and Long-Term Outcome after Surgical Therapy in Acute Pulmonary Embolism

Objectives: Acute pulmonary embolism is a life-threatening condition with a high mortality. The treatment is a matter of debate. Early and late outcomes of patients in a single center with acute pulmonary embolism treated with surgical pulmonary embolectomy were analyzed.

Methods: All consecutive patients operated on for pulmonary embolism between January 2002 and March 2017 were reviewed. Patient demographics and clinical pre- and postoperative data were retrieved from our local patient registry. Risk factors for in-hospital and long-term mortality were identified.

Results: In total 175 patients (mean age 59 3, 50% male) were operated for acute pulmonary embolism. In- hospital mortality was 19% (34/175). No differences were found comparing beating heart or cardioplegic arrest approaches. Risk factors for in-hospital mortality were age > 70 (OR 4.8, CI 1.7–13.1, p = 0.002), body surface area < 2 m² (OR 4.7, CI 1.6–13.7, p = 0.004), preoperative resuscitation (OR 14.1, CI 4.9–40.8, p < 0.001), and the absence of deep vein thrombosis (OR 9.6, CI 2.5–37.6, p < 0.001). Follow-up was 100% with a 10 year survival rate of 66.4% in 141/175 patients. In-hospital mortality rates in patients < 70 years or a body surface area > 2 m² was only 12% (p < 0.001). Once discharged from hospital none of the risk factors identified for in-hospital mortality were relevant for survival except the absence of deep vein thrombosis as a reason for pulmonary embolism (OR 3.2, CI 1.2–8.2, p = 0.019). The presence of a malignancy was a relevant risk factor for long-term mortality (OR 4.3, CI 1.8–10.3, p = 0.001).

Conclusion: Surgical pulmonary embolectomy as a therapy for acute pulmonary embolism shows good short and long-term results in patients with a life threatening disease. Especially in younger patients with a body surface area > 2m² and pulmonary embolism caused by deep vein thrombosis pulmonary embolectomy should not be a treatment of last resort reserved for clinically desperate circumstances.