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.
