title: Surgical embolectomy for acute massive pulmonary embolism.
abstract: OBJECTIVE
  Acute massive pulmonary embolism (PE) is associated with significant mortality rate despite diagnostic and therapeutic advances. The aim of this study was to analyze our clinical outcomes of patients with acute massive PE who underwent emergency surgical pulmonary embolectomy.
  
  
  METHODS
  This retrospective study included 13 consecutive patients undergoing emergency surgical pulmonary embolectomy for acute massive PE at our institution from March 2000 to November 2013. The medical records of all patients were reviewed for demograhic and preoperative data and postoperative outcomes. All patients presented with cardiogenic shock with severe right ventricular dysfunction confirmed by echocardiography, where 4 (30.8%) of the patients experienced cardiac arrest requiring cardiopulmonary resuscitation before surgery.
  
  
  RESULTS
  The mean age of patients was 61.8 ± 14 years (range, 38 to 82 years) with 8 (61.5%) males. The most common risk factors for PE was the history of prior deep venous thrombosis (n = 9, 69.2%). There were 3 (23.1%) in-hospital deaths including operative mortality of 7.7% (n = 1). Ten (76.9%) patients survived and were discharged from the hospital. The mean follow-up was 25 months; follow-up was 100% complete in surviving patients. There was one case (7.7%) of late death 12 months after surgery due to renal carcinoma. Postoperative echocardiographic pressure measurements demonstrated a significant reduction (P < 0.001). At final follow-up, all patients were in New York Heart Association class I and no readmission for a recurrent of PE was observed.
  
  
  CONCLUSIONS
  Surgical pulmonary embolectomy is a reasonable option and could be performed with acceptable results, if it is performed early in patients with acute massive PE who have not reached the profound cardiogenic shock or cardiac arrest.
authors: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital Bursa 16330, Turkey.
authors: Senol
authors: S
authors: Yavuz
authors: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital Bursa 16330, Turkey.
authors: Faruk
authors: F
authors: Toktas
authors: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital Bursa 16330, Turkey.
authors: Tugrul
authors: T
authors: Goncu
authors: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital Bursa 16330, Turkey.
authors: Cuneyt
authors: C
authors: Eris
authors: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital Bursa 16330, Turkey.
authors: Arif
authors: A
authors: Gucu
authors: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital Bursa 16330, Turkey.
authors: Derih
authors: D
authors: Ay
authors: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital Bursa 16330, Turkey.
authors: Burak
authors: B
authors: Erdolu
authors: Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa 16330, Turkey.
authors: Erhan
authors: E
authors: Tenekecioglu
authors: Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa 16330, Turkey.
authors: Kemal
authors: K
authors: Karaagac
authors: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital Bursa 16330, Turkey.
authors: Hakan
authors: H
authors: Vural
authors: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital Bursa 16330, Turkey.
authors: Ahmet
authors: A
authors: Ozyazicioglu
keywords: Acute massive pulmonary embolism; cardiopulmonary bypass; emergency operation; surgical embolectomy; thrombus