Korean J Thorac Cardiovasc Surg.  2019 Apr;52(2):78-84. 10.5090/kjtcs.2019.52.2.78.

Acute Pulmonary Thromboembolism: 14 Years of Surgical Experience

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea. dbricasa@aumc.ac.kr

Abstract

BACKGROUND
Pulmonary thromboembolism (PTE) is a life-threatening disease with high mortality. This study aimed to assess the outcomes of surgical embolectomy and to clarify the sustained long-term effects of surgery by comparing preoperative, postoperative, and long-term follow-up echocardiography outcomes. Of 22 survivors, 21 were followed up for a mean (median) period of 6.8±5.4 years (4.2 years).
METHODS
We retrospectively reviewed 27 surgical embolectomy cases for massive or submassive acute PTE from 2003 to 2016. Immediate and long-term follow-up outcomes of surgical embolectomy were assessed on the basis of 30-day mortality, long-term mortality, postoperative complications, right ventricular systolic pressure, and tricuspid regurgitation grade.
RESULTS
The 30-day and long-term mortality rates were 14.8% (4 of 27) and 4.3% (1 of 23), respectively. Three patients had major postoperative complications, including hypoxic brain damage, acute kidney injury, and endobronchial bleeding, respectively (3.7% each). Right ventricular systolic pressure (median [range], mm Hg) decreased from 62.0 (45.5-78.5) to 31.0 (25.7-37.0, p<0.001). The tricuspid valve regurgitation grade (median [range]) decreased from 1.5 (0.63-2.00) to 0.50 (0.50-1.00, p<0.05). The improvement lasted until the last echocardiographic follow-up.
CONCLUSION
Surgical embolectomy revealed favorable mortality and morbidity rates in patients with acute massive or submassive PTE, with sustained long-term improvements in cardiac function.

Keyword

Pulmonary embolism; Outcomes; Surgery, complications; Cardiopulmonary bypass; Echocardiography
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