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2015 ; 11
(3
): 208-13
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Surgical embolectomy in the management of massive and sub-massive pulmonary
embolism: The results of 30 consecutive ill patients
#MMPMID26405455
Azari A
; Bigdelu L
; Moravvej Z
ARYA Atheroscler
2015[May]; 11
(3
): 208-13
PMID26405455
show ga
BACKGROUND: Despite the improvement in the diagnosis and treatment of acute
pulmonary embolism, it is yet a common clinical problem. The actual role of open
embolectomy has not been well understood. The present report aimed to extrapolate
the outcome of early open pulmonary 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 emergency embolectomy at Ghaem
Hospital, Mashhad, Iran during January 2005 to November 2012. All patients with
an indication for pulmonary embolectomy according to recent American Heart
Association guideline were enrolled in this study. Echocardiographic features,
pulmonary artery pressure, and right ventricular (RV) diameter were recorded. The
patients were followed up monthly by two cardiologists. RESULTS: Indications for
operation in descending order consisted of contraindication for fibrinolytic
therapy (30%), failure to respond to fibrinolysis (26.66%), cardiopulmonary
arrest (20%), patent foramen ovale (20%), right atrium clot (10%), and
cardiogenic shock (10%). Mean pulmonary artery pressures were 52.26 ± 6.54 and
29.43 ± 2.87 mmHg before and after the operation, respectively (P < 0.0001). RV
function and diameter improved significantly after surgery (P < 0.0001 and <
0.0001, respectively). Complete follow-up was performed in all surviving
patients. All patients survived the operation, except one who died 2 days after
surgery due to profound hypotension. CONCLUSION: Short and long-term outcomes of
early open embolectomy seemed to be satisfactory in high-risk patients presenting
high clot burden in central pulmonary arteries. This study demonstrated that
pulmonary embolectomy may play a promising role in the management of AMPE and
ASMPE and recommended for future clinical trials.