title: Early and late clinical outcomes of pulmonary embolectomy for acute massive pulmonary embolism.
abstract: BACKGROUND
  The aim of this study was to investigate the early and late outcomes of patients undergoing pulmonary embolectomy for acute massive pulmonary embolus.
  
  
  METHODS
  Twenty-one patients (15 male, 6 female) underwent pulmonary embolectomy at our institution between March 2001 and July 2010. The median age was 55 years (range, 24 to 70 years). Of these, 9 patients presented with out-of-hospital cardiac arrest and 8 presented with New York Heart Association class III or IV. Sixteen patients underwent preoperative transthoracic echocardiography, which showed evidence of right ventricular dilatation in all, whereas in 14 patients (66.6%) pulmonary artery pressures were significantly elevated with moderate to severe tricuspid regurgitation. The median preoperative Euroscore was 9 (range, 3 to 16), and 11 patients (52.1%) received systemic thrombolysis preoperatively. There were 6 salvage (28.5%), 10 emergency (47.6%), and 5 urgent (23.8%) procedures. Concomitant procedures were performed in 3 patients (14.2%), and surgery was performed without the use of cardiopulmonary bypass in 3 patients (14.2%). The median follow-up was 38 months (range, 0 to 114 months).
  
  
  RESULTS
  The in-hospital mortality was 19% (n = 4). Postoperative complications included stroke (n = 3, 14.2%), lower respiratory tract infection (n = 6, 28.5%), wound infection (n = 3, 14.2%), acute renal failure requiring hemofiltration (n = 4, 19%), and supraventricular tachyarrhythmias (n = 4, 19%). At discharge, transthoracic echocardiography showed mild to moderate right ventricular dysfunction and dilatation in 11 survivors (64.7%). Two patients died during follow-up, and actuarial survival at 5 years was 76.9% ± 10.1% and at 8 years was 51.2% ± 22.0%. At final follow-up, 11 of the 15 survivors (73.3%) were New York Heart Association class I, and no patients required further intervention.
  
  
  CONCLUSIONS
  Patients who undergo surgery for massive pulmonary embolism have an acceptable outcome despite being high-risk.
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, United Kingdom.
authors.forename: Hunaid A
authors.initials: HA
authors.lastname: Vohra
authors.forename: Robert N
authors.initials: RN
authors.lastname: Whistance
authors.forename: Kavitha
authors.initials: K
authors.lastname: Mattam
authors.forename: Marrkku
authors.initials: M
authors.lastname: Kaarne
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Haw
authors.forename: Clifford W
authors.initials: CW
authors.lastname: Barlow
authors.forename: Geoffrey M K
authors.initials: GM
authors.lastname: Tsang
authors.forename: Steve A
authors.initials: SA
authors.lastname: Livesey
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Ohri
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000368:Aged; D000792:Angiography; D004452:Echocardiography; D017128:Embolectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult