Surgical Pulmonary Embolectomy Outcomes for Acute Pulmonary Embolism
| Autor: | Thomas J. O’Malley, Martín Mellado, Geno J. Merli, Vakhtang Tchantchaleishvili, Gregary D. Marhefka, Nicholas D. D’Antonio, Frances Mae West, Matthew P. Weber, Jae Hwan Choi, Bharat Awsare, Elizabeth J. Maynes, Carin F. Gonsalves, Taki Galanis |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
business.industry medicine.medical_treatment Embolectomy Perioperative Thrombolysis 030204 cardiovascular system & hematology medicine.disease Intensive care unit Confidence interval Pulmonary embolism law.invention 03 medical and health sciences Catheter 0302 clinical medicine 030228 respiratory system law medicine.artery Anesthesia Pulmonary artery medicine Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 110:1072-1080 |
| ISSN: | 0003-4975 |
| Popis: | Background Acute pulmonary embolism (PE) is associated with significant mortality. Surgical embolectomy is a viable treatment option; however, it remains controversial as a result of variable outcomes. This review investigates patient outcomes after surgical embolectomy for acute PE. Methods An electronic search was performed to identify articles reporting surgical embolectomy for treatment of PE. 32 studies were included comprising 936 patients. Demographic, perioperative, and outcome data were extracted and pooled for systematic review. Results Mean patient age was 56.3 years (95% confidence interval [CI], 52.5, 60.1), and 50% were male (95% CI, 46, 55); 82% had right ventricular dysfunction (95% CI, 62, 93), 80% (95% CI, 67, 89) had unstable hemodynamics, and 9% (95% CI, 5, 16) experienced cardiac arrest. Massive PE and submassive PE were present in 83% (95% CI, 43, 97)] and 13% (95% CI, 2, 56) of patients, respectively. Before embolectomy, 33% of patients (95% CI, 14, 60) underwent systemic thrombolysis, and 14% (95% CI, 8, 24) underwent catheter embolectomy. Preoperatively, 47% of patients were ventilated (95% CI, 26; 70), and 36% had percutaneous cardiopulmonary support (95% CI, 11, 71). Mean operative time and mean cardiopulmonary bypass time were 170 minutes (95% CI, 101, 239) and 56 minutes (95% CI, 42, 70), respectively. Intraoperative mortality was 4% (95% CI, 2, 8). Mean hospital and intensive care unit stay were 10 days (95% CI, 6, 14) and 2 days (95% CI, 1, 3), respectively. Mean postoperative systolic pulmonary artery pressure (sPAP) was significantly decreased from the preoperative period (sPAP 57.8, mm Hg; 95% CI, 53, 62.7) to the postoperative period (sPAP, 31.3 mm Hg; 24.9, 37.8); P Conclusions Surgical embolectomy is an acceptable treatment option with favorable outcomes. |
| Databáze: | OpenAIRE |
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