Short-term outcome after surgical embolectomy in pulmonary embolism: A single-center experience

Objectives: Although pulmonary embolism (PE) may represent a life-threatening condition with a persisting high mortality the optimal patient management in cases where thrombolysis is contraindicated or has failed is still uncertain. We here report the short-term outcome after surgical embolectomy at our department.

Methods: Retrospective data from 44 patients who underwent surgical pulmonary embolectomy for submassive or massive PE using cardio-pulmonary bypass at our department between 2002 and 2013 was analysed.

Results: Mean age of patients was 56 years (± 17, range 18-90). 20 Patients were female (45%). In 23 patients (52%), PE occurred in association with a recent surgical procedure. 8 patients (20%) had undergone unsuccessful thrombolysis. 10 patients (27%) reached the operating theatre under mechanical resuscitation. Mean operating time was 197 (± 83) minutes, mean bypass time was 107 (± 47) minutes. Mean intensive care unit (ICU) admission for these patients was 8 (± 9, range 1-30) days. Intra-hospital mortality was 22% (10/44). 50% of these patients had suffered from circulatory arrest pre-operatively. 4 Patients received ECMO treatment post-operatively of which 2 died during the post-operative course. Mean follow-up was 4 (± 3, range 0.5-9) years. 3 patients died after discharge (9%).

Conclusions: Although any interpretation of the data presented here is limited by the small number of patients and the retrospective design, surgical pulmonary embolectomy is a feasible option in a clinical bail-out situation. However, further studies are needed to improve patient selection and thus, outcome.