title: Acute surgical pulmonary embolectomy: a 9-year retrospective analysis.
abstract: Acute pulmonary embolism is a substantial cause of morbidity and death. Although the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines recommend surgical pulmonary embolectomy in patients with acute pulmonary embolism associated with hypotension, there are few reports of 30-day mortality rates. We performed a retrospective review of acute pulmonary embolectomy procedures performed in 96 consecutive patients who had severe, globally hypokinetic right ventricular dysfunction as determined by transthoracic echocardiography. Data on patients who were treated from January 2003 through December 2011 were derived from health system databases of the New York State Cardiac Surgery Reporting System and the Society of Thoracic Surgeons. The data represent procedures performed at 3 tertiary care facilities within a large health system operating in the New York City metropolitan area. The overall 30-day mortality rate was 4.2%. Most patients (68 [73.9%]) were discharged home or to rehabilitation facilities (23 [25%]). Hemodynamically stable patients with severe, globally hypokinetic right ventricular dysfunction had a 30-day mortality rate of 1.4%, with a postoperative mean length of stay of 9.1 days. Comparable findings for hemodynamically unstable patients were 12.5% and 13.4 days, respectively. Acute pulmonary embolectomy can be a viable procedure for patients with severe, globally hypokinetic right ventricular dysfunction, with or without hemodynamic compromise; however, caution is warranted. Our outcomes might be dependent upon institutional capability, experience, surgical ability, and careful patient selection.
authors: Alan R
authors: AR
authors: Hartman
authors: Frank
authors: F
authors: Manetta
authors: Ronald
authors: R
authors: Lessen
authors: Renee
authors: R
authors: Pekmezaris
authors: Andrzej
authors: A
authors: Kozikowski
authors: Lynda
authors: L
authors: Jahn
authors: Meredith
authors: M
authors: Akerman
authors: Martin L
authors: ML
authors: Lesser
authors: Lawrence R
authors: LR
authors: Glassman
authors: Michael
authors: M
authors: Graver
authors: Jacob S
authors: JS
authors: Scheinerman
authors: Robert
authors: R
authors: Kalimi
authors: Robert
authors: R
authors: Palazzo
authors: Sheel
authors: S
authors: Vatsia
authors: Gustave
authors: G
authors: Pogo
authors: Michael
authors: M
authors: Hall
authors: Pey-Jen
authors: PJ
authors: Yu
authors: Vijay
authors: V
authors: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017128:Embolectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009519:New York City; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016278:Ventricular Function, Right
keywords: Pulmonary embolism/mortality/surgery; retrospective studies; treatment outcome