title: Outcomes After Surgical Pulmonary Embolectomy for Acute Pulmonary Embolus: A Multi-Institutional Study.
abstract: BACKGROUND
  Surgical pulmonary embolectomy (SPE) has been sparingly used for the successful treatment of massive and submassive pulmonary emboli. To date, all data regarding SPE have been limited to single-center experiences. The purpose of this study was to document short-term outcomes after SPE for acute pulmonary emboli (PE) at four high-volume institutions.
  
  
  METHODS
  A retrospective review of multiple local Society of Thoracic Surgeons databases of adults undergoing SPE from 1998 to 2014 for acute PE was performed (n = 214). Demographic, operative, and outcomes data were collected and analyzed. Patients were summarily categorized as having either massive or submassive PEs based on the presence or absence of preoperative vasopressors.
  
  
  RESULTS
  A total of 214 patients with acute PE were treated by SPE. The mean age was 56.0 ± 14.5 years, and 92 (43.6%) patients were female. Of those, 176 (82.2%) PEs were submassive and 38 (17.8%) were massive. Fifteen (7.0%) patients underwent concomitant cardiac procedures, with 10 (4.7%) having simultaneous valvular interventions and 5 (2.4%) undergoing concomitant bypass grafting. Cardiopulmonary bypass (CPB) was used for all cases. Cardioplegic arrest was used for 80 (37.4%) patients. The median CPB and aortic cross clamp times were 71.5 (interquartile range [IQR], 47.0-109.5) and 46.0 (IQR, 26.0-74.5), respectively. Notably, only 25 (11.7%) patients died in the hospital. Mortality was highest among the 28 patients who experienced preoperative cardiac arrest (9, 32.1%) CONCLUSIONS: These data represent the first multicenter experience with SPE for acute pulmonary emboli. Surgical pulmonary embolectomy for acute massive and submassive PE is safe and can be performed with acceptable in-hospital outcomes; the procedure should be included in the multimodality treatment of life-threatening pulmonary emboli.
authors.affiliation: Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia. Electronic address: brent.keeling@emory.edu.
authors.forename: W Brent
authors.initials: WB
authors.lastname: Keeling
authors.affiliation: Division of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Thor
authors.initials: T
authors.lastname: Sundt
authors.affiliation: Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Marzia
authors.initials: M
authors.lastname: Leacche
authors.affiliation: Division of Cardiothoracic Surgery, Kobe University, Kobe, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
authors.affiliation: Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
authors.forename: Jose
authors.initials: J
authors.lastname: Binongo
authors.affiliation: Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
authors.forename: Yi
authors.initials: Y
authors.lastname: Lasajanak
authors.affiliation: Pavilion Holdings Group, New York, New York.
authors.forename: Lishan
authors.initials: L
authors.lastname: Aklog
authors.affiliation: Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
authors.forename: Omar M
authors.initials: OM
authors.lastname: Lattouf
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D017128:Embolectomy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D016896:Treatment Outcome