Surgical Embolectomy for Acute Pulmonary Embolism: Single-Center Experience with 105 Patients

Objectives: Ideal treatment strategies for massive pulmonary embolism (PE) still remain a matter of debate. Surgical pulmonary thromboembolectomy represents a therapeutic alternative in hemodynamically unstable patients with PE and contraindications against or failed lysis. The aim of this study was to describe in-hospital survival of patients undergoing pulmonary embolectomy for acute PE.

Methods: We retrospectively analyzed data of 105 consecutive patients with PE, classified as high risk for early mortality according to the current guidelines, who underwent emergency surgical thromboembolectomy at our department from 2002 to 2020.

Result: Mean age was 58 (±15.1) years, n = 65 (62.0%) of patients were male. In n = 33 (32%) cases, concomitant procedures (e.g., coronary artery bypass grafting, valve surgery, closure of persistent foramen ovale) were performed. A total of 55 patients (52.4%) had undergone a recent surgery that was due to a tumor in 31 (29.5%) cases. Thirty (28.6%) patients had to be resuscitated preoperatively, and 12 (11.4%) patients underwent lysis prior to embolectomy. Sixteen (15.5%) patients were placed on extracorporeal membrane oxygenation (ECMO). Resternotomy due to bleeding was necessary in 9 (10.5%) patients. Stroke rate was 6.6% (n = 7). Ninety-nine (96%) patients survived surgery, and 46 (44.6%) could be extubated within 48 hours. Thirty-day mortality rate was 25% (n = 26).

Conclusion: Surgical pulmonary embolectomy has gained increasing attention as treatment option in patients with extensive PE. Further studies have to determine possible indications for this approach to improve short and long-term outcome of these patients.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021