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Ann Thorac Surg. 2018 Nov 23. pii: S0003-4975(18)31687-4. doi: 10.1016/j.athoracsur.2018.10.035. [Epub ahead of print]

The Incidence and Outcomes of Surgical Pulmonary Embolectomy in North America.

Author information

1
New York University, Langone Health, Department of Cardiothoracic Surgery, New York, NY.
2
University of Maryland School of Medicine, Division of Cardiac Surgery, Baltimore, MD. Electronic address: cpasrija@som.umaryland.edu.
3
University of Maryland School of Medicine, Division of Cardiac Surgery, Baltimore, MD.
4
Duke Clinical Research Institute, Durham, NC.

Abstract

BACKGROUND:

There has been renewed interest in surgical pulmonary embolectomy (SPE) for the treatment of pulmonary embolism, but the real-world incidence and outcomes of SPE have yet to be well described using a large, granular dataset. We, therefore, examined the modern experience with SPE in North America as reported to the Society of Thoracic Surgery Adult Cardiac Surgery Database (STS ACSD).

METHODS:

The STS ACSD was queried for all isolated SPE for the treatment of acute pulmonary embolism (2011-2015). Groups were stratified based on presentation: no cardiogenic shock (NCS), cardiogenic shock without arrest (CS), and cardiogenic shock with cardiac arrest (CS/CA). Preoperative characteristics, intraoperative variables, postoperative in-hospital complications, and operative mortality were compared. Multivariable logistic regression was performed to identify risk factors for in-hospital mortality.

RESULTS:

Of the 1,144 centers reporting during the study period, only 310 performed at least one SPE (overall mean 0.42±1.03 cases/year/center). 1,075 eligible SPE were identified (NCS=719, CS=203, CS/CA=153). Median age was 57 years (interquartile range (IQR) 45-67), 54% were male, and preoperative thrombolysis was used in 8%. Overall, operative mortality was 16%, but increased with presenting acuity (NCS=8%, CS=23%, CS/CA=44%, p<0.001). Independent predictors of operative mortality included age, obesity, cardiogenic shock, pre-operative arrest, chronic lung disease, unresponsive neurologic state, and prolonged cardiopulmonary bypass time.

CONCLUSIONS:

SPE is uncommonly performed in North America, and in selected patients, it may be associated with favorable outcomes. Nevertheless, significant mortality exists, and attention to patient presentation and other risk factors may help distinguish patients appropriate for SPE.

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