Surgical Pulmonary Embolectomy and Systematic Thrombolysis for Acute Pulmonary Embolism: A Single Center Study

Background: Pulmonary embolism (PE) is a major cause of cardiovascular mortality, often managed with anticoagulation alone. Recent data suggest more aggressive treatments might improve outcomes. This study compared systematic thrombolysis (ST) and surgical pulmonary embolectomy (SPE) for life-threatening PE. While non-surgical options are common, patients with contraindications may need SPE. There is no clear survival benefit of thrombolysis over SPE, and thrombolysis carries higher risks of bleeding and recurrent PE. Literature on optimal treatment remains inconsistent. The aim of this study to evaluate our institutional experience with SPE and thrombolysis in 98 patients.

Methods: A retrospective study at a single German heart center compared outcomes of surgical pulmonary embolectomy (SPE) and systematic thrombolysis (ST) for acute PE in 98 patients between 2015 and 2023. Pre- and post-procedural data were collected, and unadjusted regression models assessed postoperative differences. This study evaluates surgical versus non-surgical treatments based on predefined endpoints.

Results: During the study period, 98 patients experienced life-threatening PE (48 treated with SPE and 48 with ST). Of these, preprocedural cardiac arrest occurred in 11 (22.9%) SPE patients and 13 (27.1%) ST patients (p = 0.56). In-hospital mortality rates were 12.5% (6 patients) for SPE and 14.5% (7 patients) for ST (p = 0.87). Hospitalization days were significantly (p = 0.01) higher in SPE with 17.72 days compared with the ST group with 11.44 days. Patients with SPE had significantly lower complications with regards to neurological deficits (p < 0.001), pulmonary embolism related death (p = 0.04), and non-life-threatening postoperative bleeding. There were no significant differences in other major complications such as MACE (major adverse cardiac events), renal insufficiency, and postoperative infections. Patients who underwent SPE were more likely to have previously received ECMO treatment (p = 0.003) while there was no difference with regards to postinterventional EMCO treatment in both groups (p = 0.7).

Conclusion: Both SPE and ST can be applied to high-risk patients. However, our study shows that surgical embolectomy can be safely applied to a more physically compromised patient collective with lower rates of PE-related mortality. Further research is necessary to define which set of unique patient characteristic may benefit most from available treatment options.

Publication History

Article published online:
11 February 2025