Midterm benefits of surgical pulmonary embolectomy for acute pulmonary embolus on right ventricular function

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 152; no. 3; pp. 872 - 878
• Main Authors: Keeling, William Brent, Leshnower, Bradley G., Lasajanak, Yi, Binongo, Jose, Guyton, Robert A., Halkos, Michael E., Thourani, Vinod H., Lattouf, Omar M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016
• Subjects: Acute Disease; Echocardiography; Embolectomy - methods; Female; Humans; Male; Middle Aged; Postoperative Complications - diagnostic imaging; Postoperative Complications - physiopathology; Pulmonary Embolism - surgery; Retrospective Studies; Treatment Outcome; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - physiopathology; PE; SPE; PERT
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2015.11.042

Surgical pulmonary embolectomy has been used for the successful treatment of massive and submassive pulmonary emboli. The purpose of this study is to document the short- and midterm echocardiographic follow-up of right ventricular function after surgical pulmonary embolectomy for acute pulmonary embolus. A retrospective review of the local Society of Thoracic Surgeons database of patients who underwent surgical pulmonary embolectomy for acute pulmonary embolectomy was conducted from 1998 to 2014 at a US academic center. Patients with chronic thrombus were excluded. The institutional echocardiographic database was searched for follow-up studies to compare markers of right ventricular function. Unadjusted outcomes were described, and quantitative comparisons were made of short- and long-term echocardiographic data. A total of 44 patients were included for analysis; 35 patients (79.5%) had a submassive pulmonary embolectomy, and 9 patients (20.5%) had a massive pulmonary embolectomy and required preoperative inotropy. Mean cardiopulmonary bypass time was 68.0 ± 40.2 minutes, and 30 patients (68.2%) underwent procedures without aortic crossclamping. There was 1 in-hospital mortality (2.3%), and there were no permanent neurologic deficits. A total of 21 patients had echocardiography results available for follow-up. Perioperative echocardiographic data showed an immediate decrease in tricuspid regurgitant velocity and right ventricular pressure (P < .05). Mean midterm echocardiographic follow-up was 30 months in 12 patients. At midterm follow-up, improvements in right ventricular function observed postoperatively persisted. Only 1 patient had moderate right ventricular dysfunction, and no patient had worse than mild tricuspid regurgitation. Mean tricuspid valve regurgitant velocity was 2.4 ± 0.7 m/s, and mean pulmonary artery systolic pressure was 37.2 ± 14.2 mm Hg. Surgical pulmonary embolectomy may represent optimal therapy in selected patients for massive and submassive acute pulmonary emboli given the low morbidity and mortality rates. Echocardiographic follow-up shows preserved improvement in right ventricular function in the majority of patients.