Surgical Thrombectomy for Pulmonary Embolism: Updated Performance Rates and Outcomes (original) (raw)
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Clinics and Practice, 2022
Pulmonary embolism (PE) is the third most common vascular disease in the US, a frequently underdiagnosed and potentially fatal condition where embolic material blocks one or more pulmonary arteries impairing blood flow. In this study, we aim to describe the prevalence, outcomes, and predictors of mortality of PE patients treated with mechanical (MT) and surgical thrombectomy (ST). This is a retrospective study using the Agency for Healthcare Research and Quality’s HCUP NIS data from 2010–2018. We used the ninth and tenth revisions of the International Classification of Diseases clinical modification codes (ICD-9-CM and ICD-10-CM) to identify patients admitted with a primary diagnosis of PE (ICD-10-CM codes I26.02, I26.09, I26.92, I26.93, I26.94, and I26.99; ICD-9-CM codes 415.11, 415.13, and 415.19). We extracted demographics, hospital-level, and patient-level characteristics, and defined the severity of comorbid conditions using Deyo modification of the Elixhauser Comorbidity Index...
The Journal of emergency medicine, 2017
Thrombolysis for the treatment of pulmonary embolism (PE) has received significant attention in the literature over the past 10 years. Our primary objective was to examine the trend in thrombolysis use in the United States from 2006 to 2011. Secondary objectives include examining patient and hospital characteristics associated with receiving thrombolysis and rates of complications associated with thrombolysis. In this retrospective cohort study, we used the Nationwide Inpatient Sample from 2006 to 2011 to identify patients with a diagnosis of PE who received or did not receive thrombolytic agents. Examining the records of 47,911,414 hospital discharges identified a cohort of 1,317,329 patients with PE; of these patients, 10,617 received thrombolysis. During the study period, there was a 30% relative increase in the use of thrombolysis, from 0.68% (95% confidence interval [CI] 0.64-0.73%) to 0.89% (95% CI 0.83-0.95%; p < 0.01). After controlling for all factors in the model, facto...
Surgical Management of Acute Pulmonary Thromboembolism: our Experience
IOSR Journal of Dental and Medical Sciences, 2016
Acute pulmonary thromboembolism (PTE) can be a life threatening complication of deep vein thrombosis. Surgical embolectomy is a rarely performed and is only reserved for hemodynamically unstable patients, those with massive pulmonary thromboembolism and those with failed thrombolysis therapy. We reviewed the results of surgical pulmonary embolectomy performed in our institute over the last four years. Data was retrospectively studied of 28 patients who underwent pulmonary embolectomy in our institute over the last four years i.e. from 2012 to 2016. Demographic data, clinical presentation and outcomes were analyzed. Clinical presentation included dyspnea (82%), hemodynamic instability requiring continuous vasopressor support (36%), echocardiographic evidence of right ventricular dilatation (82%). There was 3% mortality rate in our study which is comparably low with previous studies. Our series implies the benefit of early consideration and performance of pulmonary embolectomy in these critically ill patients.
Surgical pulmonary embolectomy in a community hospital
The American Journal of Surgery, 2014
BACKGROUND: Surgical pulmonary embolectomy (SPE) is indicated for a pulmonary embolism associated with hemodynamic instability. A review of the literature demonstrates that most studies of SPE are conducted at large academic medical centers. This series is from a 325-bed community hospital.
2010
Acute massive or submassive pulmonary embolism (PE) requires prompt diagnosis, risk-stratification and aggressive treatment. Mortality rates can rise up to 70% within the first hour of presentation and are strongly correlated with the degree of right ventricular (RV) dysfunction, cardiac arrest, and consequential congestive heart failure. While anticoagulation is universally employed, there are inadequate data to establish definitive guidelines for the management of massive PE despite the availability of multiple treatment modalities. Medical thrombolytic therapy has not been shown to significantly reduce mortality in patients with massive PE but is still widely employed, whereas surgical and catheter embolectomy are only reserved as last resort treatments for critically ill patients with hemodynamic instability, or for those who are either not candidates for or have failed thrombolysis. Following an extensive review of medical literature, we outline the treatment options for this clinical scenario while focusing on the role of surgical embolectomy. Although traditionally reserved as rescue therapy for cases of failed thrombolysis, surgical embolectomy is a safe procedure with low mortality when performed early and in a selected group of patients. Sufficient evidence exists to extend the criteria for surgical embolectomy from strictly rescue therapy to include hemodynamically stable patients with RV dysfunction. Multidisciplinary approach to this condition coupled with a meticulous surgical technique has significantly lowered the mortality associated with this surgical procedure over the last 10 years.
Revista Portuguesa de Cardiologia (English Edition), 2014
For years, the treatment of high-risk pulmonary embolism (PE) was based on two well-defined strategies: thrombolysis, whose benefits have been documented in randomized trials, and surgical embolectomy. However, mechanical reperfusion by percutaneous techniques is used in an increasing number of patients, and is a valid therapeutic option when there is a formal contraindication to thrombolysis, as rescue therapy when thrombolysis fails to improve hemodynamics, and/or when emergency surgical thrombectomy is unavailable or contraindicated. This article discusses the indications for the use of percutaneous techniques in PE, reports the initial experience of our center with the AngioJet ® thrombectomy device (Possis Medical Inc., Minneapolis, MN, USA) and reviews the available evidence, the most recent recommendations and the main complications associated with this procedure.
Interactive cardiovascular and thoracic surgery, 2012
Massive pulmonary embolism is relatively rare but a potentially life-threatening condition. The purpose of this study was to analyse the outcome of pulmonary embolectomy in registered data from the Japanese Society of Pulmonary Embolism Research (JaSPER). From 1994 to 2006, 1661 cases of acute pulmonary embolism were registered in the JaSPER database. Retrospective analysis of 32 patients undergoing pulmonary embolectomy was conducted. The overall incidence of pulmonary embolectomy was 1.9% [95% confidence interval (CI): 1.8-3.2%]. The mean age of patients was 57 years and 66% were female. Overall mortality of pulmonary embolectomy was 18.8% [95% CI: 5.2-25.6%]. Most of the patients had massive or submassive pulmonary thromboembolism, and three patients experienced cardiopulmonary arrest before embolectomy. Ten patients received preoperative percutaneous cardiopulmonary bypass, and mortality was 30% in this subgroup. Pulmonary embolectomy is an effective therapeutic option for patie...
Acute Surgical Pulmonary Embolectomy: A 9-Year Retrospective Analysis
Texas Heart Institute Journal, 2015
Acute pulmonary embolism is a substantial cause of morbidity and death. Although the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines recommend surgical pulmonary embolectomy in patients with acute pulmonary embolism associated with hypotension, there are few reports of 30-day mortality rates. We performed a retrospective review of acute pulmonary embolectomy procedures performed in 96 consecutive patients who had severe, globally hypokinetic right ventricular dysfunction as determined by transthoracic echocardiography. Data on patients who were treated from January 2003 through December 2011 were derived from health system databases of the New York State Cardiac Surgery Reporting System and the Society of Thoracic Surgeons. The data represent procedures performed at 3 tertiary care facilities within a large health system operating in the New York City metropolitan area. The overall 30-day mortality rate was 4.2%. Most patients (68 [73.9%]) were disch...
Outcomes of Pulmonary Embolectomy for Acute Pulmonary Embolism
Circulation journal : official journal of the Japanese Circulation Society, 2018
Acute pulmonary embolism (PE) is a major threat to the health and lives of hospitalized patients. This study was conducted to clarify the real-world outcomes of pulmonary embolectomy.Methods and Results:Retrospective investigation of 355 patients who underwent pulmonary embolectomy for acute PE was conducted using the Japanese Cardiovascular Surgery Database. Risk factors for operative death within 30 days after pulmonary embolectomy and major adverse cardiovascular events (MACE), including operative death, postoperative stroke and postoperative coma, were analyzed. Cardiopulmonary resuscitation (CPR) was required preoperatively in 27.6%, and preoperative veno-arterial extracorporeal membrane oxygenation was performed in 26.5%. Urgent or emergency operation was performed in 93% of patients. Operative mortality rate was 73/355 (20.6%). Incidence of MACE was 97/355 (27.3%). In univariate analysis, preoperative predictors of death were obesity, renal dysfunction, chronic obstructive pu...