title: Early and late results after surgery for massive pulmonary embolism.
abstract: Between 1978 and 1990 emergency pulmonary embolectomy with the aid of extracorporeal circulation (ECC) was performed for massive pulmonary embolism (PE) in 44 patients (19-73 yrs; 49 +/- 15 yrs). Cardiopulmonary circulation was stable in 16/44 patients but unstable in 28/44; of the latter, 15 had undergone previous cardiopulmonary resuscitation due to cardiac arrest. Diagnosis of PE was obtained clinically in 15/44 patients, by angiography in 13/44, by echocardiography in 10/44, and by perfusion scintigraphy of the lung in 6/44 patients. There were 9/44 (20%) postoperative deaths. Early mortality was significantly higher in previously resuscitated patients (p less than 0.05). There were 2/36 (6%) late deaths. Actuarial survival was 75% after 4 yrs and 71% after 8 yrs. 77% or 35 survivors were in NYHA-class I and 23% in NYHA-class II after a mean follow-up of 4.6 yrs. Pulmonary embolectomy is indicated in patients with central PE and shock; it is advisable in patients with embolism of the main pulmonary artery or its major branches or in patients with contraindication to thrombolysis. Intraoperative insertion of a vena cava filter is recommended for prevention of recurrent embolism. Preoperative resuscitation and duration of ECC are predictors for early death.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
authors.forename: E P
authors.initials: EP
authors.lastname: Bauer
authors.forename: A
authors.initials: A
authors.lastname: Laske
authors.forename: L K
authors.initials: LK
authors.lastname: von Segesser
authors.forename: T
authors.initials: T
authors.lastname: Carrel
authors.forename: M I
authors.initials: MI
authors.lastname: Turina
mesh_terms: D000206:Actuarial Analysis; D004630:Emergencies; D005112:Extracorporeal Circulation; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011655:Pulmonary Embolism / Q000401:mortality / Q000601:surgery*; D012151:Resuscitation; D013997:Time Factors; D016306:Vena Cava Filters