Aggressive surgical treatment of acute pulmonary embolism with circulatory collapse.
BACKGROUND
Acute high-risk pulmonary embolism is a life-threatening condition with high early mortality rates resulting from acute right ventricular failure and cardiogenic shock. We retrospectively analyzed the outcomes of surgical embolectomy among patients with circulatory collapse.


METHODS
Between July 2000 and September 2011, 24 consecutive patients (17 women and 7 men; mean age, 59.9±17.2 years) underwent emergency surgical embolectomy to treat acute pulmonary embolism with circulatory collapse. Nineteen (79.2%) patients were in cardiogenic shock, and 16 (66.7%) patients received preoperative percutaneous cardiopulmonary support. Eleven (45.8%) patients were in cardiac arrest. The preoperative pulmonary artery obstruction index was 76.9%±16.4% (median, 88.9%; range, 44.4%-88.9%). The indications for surgical intervention were cardiogenic shock (n=16 [66.7%]), failed medical therapy or catheter embolectomy (n=4 [16.7%]), or contraindication for thrombolysis (n=4 [16.7%]). Follow-up was 100% complete with a mean of 6.8±3.9 years (median, 5.6 years).


RESULTS
The in-hospital mortality rate was 12.5% (n=3). One patient underwent a repeated embolectomy on postoperative day 6. The postoperative course was complicated by cerebral infarction and by mediastinitis in 1 patient each. The 5-year cumulative survival rate was 87.5%±6.8%. Mean right ventricular pressure significantly decreased from 66.9 to 28.5 mm Hg among the survivors.


CONCLUSIONS
Surgical pulmonary embolectomy is an excellent approach to treating acute pulmonary embolism with circulatory collapse. Providing immediate percutaneous cardiopulmonary support to patients with cardiogenic shock could help to resuscitate and stabilize cardiopulmonary function and allow for a good outcome of pulmonary embolectomy.
Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Hiroaki
H
Takahashi
Kenji
K
Okada
Masamichi
M
Matsumori
Hiroya
H
Kano
Atsushi
A
Kitagawa
Yutaka
Y
Okita
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass / Q000379:methods; D015331:Cohort Studies; D016638:Critical Illness; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012769:Shock / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D017131:Thrombectomy / Q000379:methods / Q000401:mortality*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000401:mortality / Q000601:surgery
D000925:Anticoagulants