Surgical embolectomy in the management of massive and sub-massive pulmonary embolism: the results of 30 consecutive ill patients

Background: despite the improvement in the diagnosis and treatment of acute pulmonaryembolism, it is yet a common clinical problem. the actual role of open embolectomy has notbeen well understood. the present report aimed to extrapolate the outcome of early openpulmonary embolectomy in a number of patients with acute (sub) massive pulmonary embolism(ampe/asmpe).methods: a prospective study was performed on 30 patients who underwent emergencyembolectomy at ghaem hospital, mashhad, iran during january 2005 to november 2012. allpatients with an indication for pulmonary embolectomy according to recent american heartassociation guideline were enrolled in this study. echocardiographic features, pulmonary arterypressure, and right ventricular (rv) diameter were recorded. the patients were followed upmonthly by two cardiologists.results: indications for operation in descending order consisted of contraindication forfibrinolytic therapy (30%), failure to respond to fibrinolysis (26.66%), cardiopulmonary arrest(20%), patent foramen ovale (20%), right atrium clot (10%), and cardiogenic shock (10%). meanpulmonary artery pressures were 52.26 ± 6.54 and 29.43 ± 2.87 mmhg before and after theoperation, respectively (p < 0.0001). rv function and diameter improved significantly aftersurgery (p < 0.0001 and < 0.0001, respectively). complete follow-up was performed in allsurviving patients. all patients survived the operation, except one who died 2 days after surgerydue to profound hypotension.conclusion: short and long-term outcomes of early open embolectomy seemed to besatisfactory in high-risk patients presenting high clot burden in central pulmonary arteries. thisstudy demonstrated that pulmonary embolectomy may play a promising role in themanagement of ampe and asmpe and recommended for future clinical trials.