HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Doerge, H. C. Articles by Messmer, B. J. Search for Related Content PubMed PubMed Citation Articles by Doerge, H. C. Articles by Messmer, B. J.

European Journal of Cardio-Thoracic Surgery, Vol 10, 952-957, Copyright © 1996 by European Association for Cardio-thoracic Surgery

ARTICLES

Pulmonary embolectomy: review of a 15-year experience and role in the age of thrombolytic therapy

HC Doerge, FA Schoendube, H Loeser, M Walter and BJ Messmer
Klinikum Aachen, Germany.

OBJECTIVE: Surgical intervention for fulminant pulmonary embolism is nowadays most commonly restricted to patients with failure of or contraindication to thrombolytic therapy. Such a second choice indication may alter operative risks or late outcome, and this was investigated in a retrospective study. MATERIAL AND METHODS: Thirty-six patients (17 male, mean age: 50.6 +/- 15.5 years) with fulminant pulmonary embolism of either the pulmonary trunk or one of the pulmonary arteries and at least one contralateral segment underwent pulmonary embolectomy on cardiopulmonary bypass during a 15-year period (1979-89: 31 patients, group I; 1990-94: 5 patients, group II). Group II included only patients who did not meet the criteria for acute thrombolysis. All patients were in strongly compromised circulatory conditions (29/36 high dose catecholamines, 20/36 mechanical ventilation, 14/36 pre-operative cardiopulmonary resuscitation). RESULTS: The perioperative mortality rate was 26% in group I (8/31 patients, 7 with pre-operative cardiac arrest) and 20% in group II (1/5 patients not related to failure of previous thrombolytic therapy). Severe but non-fatal complications occurred in six patients who fully recovered following treatment. Follow-up was completed to 93% (25/27 patients) and comprised a total of 248 patient-years (mean: 119 months). Twenty-three out of 25 patients (92%) were in functional class I or II (NYHA). No recurrent pulmonary embolism or late clinical symptoms related to embolectomy were observed. One patient died 8 years postoperatively (late mortality: 0.4% patient-year). There was no difference between group I and group II regarding perioperative mortality, complications and late results. CONCLUSIONS: Late results after pulmonary embolectomy are excellent in respect to functional class and late mortality. Early mortality is closely associated with preoperative cardiac arrest. Previous thrombolysis does not alter the perioperative risks, occurrence of complications or late outcome after surgical intervention.

This article has been cited by other articles:

				I. M. Lang Management of acute and chronic RV dysfunction Eur. Heart J. Suppl., December 1, 2007; 9(suppl_H): H61 - H67. [Abstract] [Full Text] [PDF]

				G. Stratmann and G. A. Gregory Neurogenic and Humoral Vasoconstriction in Acute Pulmonary Thromboembolism Anesth. Analg., August 1, 2003; 97(2): 341 - 354. [Full Text] [PDF]

				G. S. Ahearn, D. Hadjiliadis, J. A. Govert, and V. F. Tapson Massive Pulmonary Embolism During Pregnancy Successfully Treated With Recombinant Tissue Plasminogen Activator: A Case Report and Review of Treatment Options Arch Intern Med, June 10, 2002; 162(11): 1221 - 1227. [Full Text] [PDF]

				G. Trummer, M. Berchtold-Herz, J. Martin, and F. Beyersdorf Successful treatment of pulmonary hypertension with inhaled nitric oxide after pulmonary embolectomy Ann. Thorac. Surg., April 1, 2002; 73(4): 1299 - 1301. [Abstract] [Full Text] [PDF]

				K. E. Wood Major Pulmonary Embolism : Review of a Pathophysiologic Approach to the Golden Hour of Hemodynamically Significant Pulmonary Embolism Chest, March 1, 2002; 121(3): 877 - 905. [Abstract] [Full Text] [PDF]

				I. Kurkciyan, G. Meron, F. Sterz, K. Janata, H. Domanovits, M. Holzer, A. Berzlanovich, H. C. Bankl, and A. N. Laggner Pulmonary Embolism as Cause of Cardiac Arrest: Presentation and Outcome Arch Intern Med, May 22, 2000; 160(10): 1529 - 1535. [Abstract] [Full Text] [PDF]

				K. L. Peterson Acute Pulmonary Thromboembolism : Has Its Evolution Been Redefined? Circulation, March 16, 1999; 99(10): 1280 - 1283. [Full Text] [PDF]