title: Pulmonary embolectomy in the treatment of submassive and massive pulmonary embolism.
abstract: OBJECTIVE
  Significant improvements in outcomes after pulmonary embolectomy have resulted in a broadening of indications. We reviewed our experience with pulmonary embolectomy over the past 12 years with an emphasis on preoperative comorbidities and postoperative morbidity and mortality.
  
  
  METHODS
  All patients undergoing pulmonary embolectomy over the past 12 years at our institution were analyzed via retrospective chart review. Data on preoperative characteristics, operative procedures and postoperative outcomes were collected.
  
  
  RESULTS
  Twenty patients underwent pulmonary embolectomy between 1999 and 2011. The average age was 56 years (range 24-81) and 10 patients (50%) were female. All patients demonstrated right ventricular dysfunction and 19 (95%) demonstrated contraindications to thrombolysis. Twelve patients (60%) demonstrated intermittent hypotension, 4 (20%) required intubation and 3 (15%) demonstrated preoperative or intraoperative cardiac arrest. Survival to discharge was 95%.
  
  
  CONCLUSIONS
  Pulmonary embolectomy has been shown to be safe and effective in the treatment of massive pulmonary embolism (PE). We achieved a 95% survival rate in a cohort of patients with significant comorbid status. Pulmonary embolectomy should be considered early in the therapeutic algorithm for patients with submassive PE presenting with right ventricular dysfunction to prevent progression. It can also be performed with good outcomes in those already suffering hemodynamic compromise.
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College/New York Presbyterian Hospital, New York, N.Y., USA.
authors.forename: Berhane
authors.initials: B
authors.lastname: Worku
authors.forename: Iosif
authors.initials: I
authors.lastname: Gulkarov
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Girardi
authors.forename: Arash
authors.initials: A
authors.lastname: Salemi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017128:Embolectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011655:Pulmonary Embolism / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000601:surgery; D055815:Young Adult