DOI QR코드

DOI QR Code

Acute Pulmonary Thromboembolism: 14 Years of Surgical Experience

  • Park, Jiye (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine) ;
  • Lim, Sang-Hyun (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine) ;
  • Hong, You Sun (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine) ;
  • Park, Soojin (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine) ;
  • Lee, Cheol Joo (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine) ;
  • Lee, Seung Ook (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine)
  • Received : 2018.07.16
  • Accepted : 2018.11.12
  • Published : 2019.04.05

Abstract

Background: Pulmonary thromboembolism (PTE) is a life-threatening disease with high mortality. This study aimed to assess the outcomes of surgical embolectomy and to clarify the sustained long-term effects of surgery by comparing preoperative, postoperative, and long-term follow-up echocardiography outcomes. Of 22 survivors, 21 were followed up for a mean (median) period of $6.8{\pm}5.4years$ (4.2 years). Methods: We retrospectively reviewed 27 surgical embolectomy cases for massive or submassive acute PTE from 2003 to 2016. Immediate and long-term follow-up outcomes of surgical embolectomy were assessed on the basis of 30-day mortality, long-term mortality, postoperative complications, right ventricular systolic pressure, and tricuspid regurgitation grade. Results: The 30-day and long-term mortality rates were 14.8% (4 of 27) and 4.3% (1 of 23), respectively. Three patients had major postoperative complications, including hypoxic brain damage, acute kidney injury, and endobronchial b leeding, respectively (3.7% each). Right ventricular systolic pressure (median [range], mm Hg) decreased from 62.0 (45.5-78.5) to 31.0 (25.7-37.0, p<0.001). The tricuspid valve regurgitation grade (median [range]) decreased from 1.5 (0.63-2.00) to 0.50 (0.50-1.00, p<0.05). The improvement lasted until the last echocardiographic follow-up. Conclusion: Surgical embolectomy revealed favorable mortality and morbidity rates in patients with acute massive or submassive PTE, with sustained long-term improvements in cardiac function.

Keywords

References

  1. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999;353:1386-9. https://doi.org/10.1016/S0140-6736(98)07534-5
  2. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3033-69. https://doi.org/10.1093/eurheartj/ehu283
  3. Cho YH, Sung K, Kim WS, et al. Management of acute massive pulmonary embolism: is surgical embolectomy inferior to thrombolysis? Int J Cardiol 2016;203:579-83. https://doi.org/10.1016/j.ijcard.2015.10.223
  4. Goldhaber SZ. Pulmonary embolism. Lancet 2004;363:1295-305. https://doi.org/10.1016/S0140-6736(04)16004-2
  5. Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008;133(6 Suppl):454S-545S. https://doi.org/10.1378/chest.08-0658
  6. Stawicki SP, Seamon MJ, Meredith DM, et al. Transthoracic echocardiography for suspected pulmonary embolism in the intensive care unit: unjustly underused or rightfully ignored? J Clin Ultrasound 2008;36:291-302. https://doi.org/10.1002/jcu.20461
  7. Miniati M, Monti S, Pratali L, et al. Value of transthoracic echocardiography in the diagnosis of pulmonary embolism: results of a prospective study in unselected patients. Am J Med 2001;110:528-35. https://doi.org/10.1016/S0002-9343(01)00693-3
  8. Park JS, Ahn J, Choi JH, et al. The predictive value of echocardiography for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism in Korea. Korean J Intern Med 2017;32:85-94. https://doi.org/10.3904/kjim.2014.175
  9. Keeling WB, Leshnower BG, Lasajanak Y, et al. Midterm benefits of surgical pulmonary embolectomy for acute pulmonary embolus on right ventricular function. J Thorac Cardiovasc Surg 2016;152:872-8. https://doi.org/10.1016/j.jtcvs.2015.11.042
  10. Deakin CD, Nolan JP, Soar J, et al. European Resuscitation Council guidelines for resuscitation 2010: section 4. adult advanced life support. Resuscitation 2010;81:1305-52. https://doi.org/10.1016/j.resuscitation.2010.08.017
  11. Fiumara K, Kucher N, Fanikos J, Goldhaber SZ. Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism. Am J Cardiol 2006;97:127-9. https://doi.org/10.1016/j.amjcard.2005.07.117

Cited by

  1. Initial Experience with Non-Sternotomy Minimally Invasive Pulmonary Embolectomy with Thoracoscopic Assistance vol.15, pp.2, 2019, https://doi.org/10.1177/1556984520909803
  2. Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism: a single-centre study in China vol.15, pp.1, 2019, https://doi.org/10.1186/s13019-020-01364-z