Excellent outcome after surgical treatment of massive pulmonary embolism in critically ill patients
| Autor: | Friedrich S. Eckstein, Florian Schönhoff, Eva Krähenbühl, Thierry Carrel, FF Immer, Jürg Schmidli, Alexander Kadner |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Critical Illness medicine.medical_treatment Shock Cardiogenic Embolectomy Blood Pressure Pulmonary Artery medicine Humans Cardiopulmonary resuscitation Cardiopulmonary Bypass business.industry Cardiogenic shock Respiratory disease Middle Aged medicine.disease Pulmonary hypertension Cardiopulmonary Resuscitation Heart Arrest Surgery Pulmonary embolism Treatment Outcome Embolism Anesthesia Patent foramen ovale Female Emergencies Pulmonary Embolism Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 136:448-451 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2007.11.021 |
| Popis: | Objective Treatment of central and paracentral pulmonary embolism in patients with hemodynamic compromise remains a subject of debate, and no consensus exists regarding the best method: thrombolytic agents, catheter-based thrombus aspiration or fragmentation, or surgical embolectomy. We reviewed our experience with emergency surgical pulmonary embolectomy. Methods Between January of 2000 and March of 2007, 25 patients (17 male, mean age 60 years) underwent emergency open embolectomy for central and paracentral pulmonary embolism. Eighteen patients presented in cardiogenic shock, 8 of whom had cardiac arrest and required cardiopulmonary resuscitation. All patients underwent operation with mild hypothermic cardiopulmonary bypass. Concomitant procedures were performed in 8 patients (3 coronary artery bypass grafts, 2 patent foramen ovale closures, 4 ligations of the left atrial appendage, 3 removals of a right atrial thrombus). Follow-up is 96% complete with a median of 2 years (range, 2 months to 6 years). Results All patients survived the procedure, but 2 patients died in the hospital on postoperative days 1 (intracerebral bleeding) and 11 (multiorgan failure), accounting for a 30-day mortality of 8% (95% confidence interval: 0.98–0.26). Four patients died later because of their underlying disease. Pre- and postoperative echocardiographic pressure measurements demonstrated the reduction of the pulmonary hypertension to half of the systemic pressure values or less. Conclusion Surgical pulmonary embolectomy is an excellent option for patients with major pulmonary embolism and can be performed with minimal mortality and morbidity. Even patients who present with cardiac arrest and require preoperative cardiopulmonary resuscitation show satisfying results. Immediate surgical desobstruction favorably influences the pulmonary pressure and the recovery of right ventricular function, and remains the treatment of choice for patients with massive central and paracentral embolism with hemodynamic and respiratory compromise. |
| Databáze: | OpenAIRE |
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