title: Surgical Pulmonary Embolectomy: Experience in a Series of 37 Consecutive Cases.
abstract: BACKGROUND
  Massive pulmonary embolism is a poorly tolerated condition. Treatment options in this condition include anticoagulation and primary reperfusion therapy - systemic thrombolysis, catheter based treatments or surgical embolectomy. There is little data on the relative efficacy of each treatment.
  
  
  METHODS
  The preoperative characteristics and outcomes of patients referred for surgical embolectomy between 2000-2014 was reviewed. Echocardiography was performed in the majority of patients before and after surgery.
  
  
  RESULTS
  Thirty-seven patients underwent pulmonary embolectomy between 2000-2014. One patient died within 30 days, another before leaving hospital. All other patients were alive at the time of follow-up (survival 94.6% at median 36 months). Median ventilation time was 24hours. Median hospital length of stay was 10.5 days. There was echocardiographic evidence of severe right ventricular strain (increased size and decreased function) before surgery, which was significantly improved to within the normal range by discharge, and follow-up.
  
  
  CONCLUSIONS
  Surgical embolectomy is a safe procedure, with low mortality, improved postoperative right ventricular function and pulmonary pressure, and good long-term outcome. Early relief of a large proportion of the clot burden can be life-saving. There should be consideration for its use as an initial treatment strategy in patients with massive or submassive pulmonary embolus with a large burden of proximal clot. A multidisciplinary approach for the treatment of these patients is required.
authors.affiliation: Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; The Baird Institute, Sydney, NSW, Australia.
authors.forename: J J
authors.initials: JJ
authors.lastname: Edelman
authors.affiliation: Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Okiwelu
authors.affiliation: Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Anvardeen
authors.affiliation: Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; The Baird Institute, Sydney, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Joshi
authors.affiliation: Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Murphy
authors.affiliation: Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.
authors.forename: L H
authors.initials: LH
authors.lastname: Sanders
authors.affiliation: Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.
authors.forename: M A
authors.initials: MA
authors.lastname: Newman
authors.affiliation: Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; The Baird Institute, Sydney, NSW, Australia; School of Medicine, Fremantle - The University of Notre Dame. Electronic address: Jurgen.Passage@health.wa.gov.au.
authors.forename: J
authors.initials: J
authors.lastname: Passage
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D018572:Disease-Free Survival; D004452:Echocardiography; D017128:Embolectomy; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Pulmonary embolism; Surgical embolectomy