W Brent Keeling1, Thor Sundt2, Marzia Leacche3, Yutaka Okita4, Jose Binongo5, Yi Lasajanak5, Lishan Aklog6, Omar M Lattouf5. 1. Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia. Electronic address: brent.keeling@emory.edu. 2. Division of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts. 3. Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 4. Division of Cardiothoracic Surgery, Kobe University, Kobe, Japan. 5. Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia. 6. Pavilion Holdings Group, New York, New York.
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.
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: Belinda Rivera-Lebron; Michael McDaniel; Kamran Ahrar; Abdulah Alrifai; David M Dudzinski; Christina Fanola; Danielle Blais; David Janicke; Roman Melamed; Kerry Mohrien; Elizabeth Rozycki; Charles B Ross; Andrew J Klein; Parth Rali; Nicholas R Teman; Leoara Yarboro; Eugene Ichinose; Aditya M Sharma; Jason A Bartos; Mahir Elder; Brent Keeling; Harold Palevsky; Soophia Naydenov; Parijat Sen; Nancy Amoroso; Josanna M Rodriguez-Lopez; George A Davis; Rachel Rosovsky; Kenneth Rosenfield; Christopher Kabrhel; James Horowitz; Jay S Giri; Victor Tapson; Richard Channick Journal: Clin Appl Thromb Hemost Date: 2019 Jan-Dec Impact factor: 2.389
Authors: Best Anyama; Omar Viswanath; Carolina De La Cuesta; Murlikrishna Kannan; Michael Wittels; Steve Xydas; Alan David Kaye; David A Farcy Journal: Ochsner J Date: 2018