title: Expedient pulmonary embolectomy for acute pulmonary embolism: improved outcomes.
abstract: Indications regarding surgical pulmonary embolectomy for treatment of submassive/massive acute pulmonary embolism remain controversial. An institutional experience with pulmonary embolectomy for acute pulmonary embolism (APE) was reviewed. A retrospective analysis of all patients undergoing pulmonary embolectomy for APE from September 2004 to January 2007 was conducted. Demographic data, clinical presentation and outcomes were analyzed. Fifteen patients underwent surgery for APE over a period of 27 months [average age 59.6 (range 35-89) years, (seven male, eight female)]. Six (40%) patients were admitted with known APE and nine patients exhibited post admission APE (seven - after surgical procedures, two - after cerebrovascular accident). Clinical presentation included dyspnea (86.67%), hemodynamic instability requiring continuous vasopressor support (40%), echocardiographic evidence of right ventricular dilatation (80%). Ten patients undergoing early/expedient embolectomy all survived while delayed surgery in the other five patients (>24 h) was associated with 60% mortality. Expanding indications for early surgical pulmonary embolectomy has stemmed from reliable echocardiographic identification of right ventricular compromise and recognition of these findings as harbingers of subsequent hemodynamic embarrassment. Our series underscores the benefit of early consideration and performance of pulmonary embolectomy in these critically ill patients.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Maimonides Medical Center, 4802 10th Avenue, 4th Floor, Brooklyn, NY 11219, USA.
authors.forename: Parvez
authors.initials: P
authors.lastname: Ahmed
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Khan
authors.forename: Alan
authors.initials: A
authors.lastname: Smith
authors.forename: Murali
authors.initials: M
authors.lastname: Pagala
authors.forename: Sunil
authors.initials: S
authors.lastname: Abrol
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Cunningham
authors.forename: Mikhail
authors.initials: M
authors.lastname: Vaynblat
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004108:Dilatation, Pathologic; D004417:Dyspnea / Q000209:etiology / Q000601:surgery; D017548:Echocardiography, Transesophageal; D017128:Embolectomy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000601:surgery