title: A more aggressive approach to emergency embolectomy for acute pulmonary embolism.
abstract: OBJECTIVE
  To examine operative outcomes after acute pulmonary embolectomy (APE), a recently adopted, more aggressive surgical approach.
  
  
  METHODS
  We retrospectively identified patients who underwent surgical APE from April 1, 2001, through March 31, 2009, and reviewed their clinical records for perioperative outcome. Operations were performed with normothermic cardiopulmonary bypass and a beating heart, absent a patent foramen ovale. For completeness, embolectomy was performed via separate incisions in the left and right pulmonary arteries (PAs) in 15 patients.
  
  
  RESULTS
  Of the 18 patients identified, the mean age was 60 years, and 13 patients (72%) were men. Thirteen patients (72%) had been hospitalized recently or had systemic disease. The preoperative diagnosis was established by echocardiography or computed tomography (or both). The median (range) follow-up time for all surviving patients was 16 months (2-74 months). Indications for APE included cardiogenic shock (n=12; 67%) and severe right ventricular dysfunction as shown by echocardiography (n=5; 28%). Seven patients (39%) had an embolus in transit. Seven patients (39%) experienced cardiopulmonary arrest before APE. Four early deaths (22%) occurred; all 4 of these patients had preoperative cardiopulmonary arrest, and 2 had APE via the main PA only, without branch PA incisions. Two late deaths (11%) occurred. Right ventricular function improved in all survivors.
  
  
  CONCLUSIONS
  The results of emergent APE are encouraging, particularly among patients without cardiopulmonary arrest. It should not be reserved for patients in extremis; rather, it should be considered for patients with right ventricular dysfunction that is an early sign of impending hemodynamic collapse.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Basar
authors.initials: B
authors.lastname: Sareyyupoglu
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.forename: Mark T
authors.initials: MT
authors.lastname: Keegan
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D017128:Embolectomy / Q000379:methods* / Q000401:mortality; D004630:Emergencies; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery; D011655:Pulmonary Embolism / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology
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