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Int J Cardiol. 2016 Jan 15;203:579-83. doi: 10.1016/j.ijcard.2015.10.223. Epub 2015 Oct 31.

Management of acute massive pulmonary embolism: Is surgical embolectomy inferior to thrombolysis?

Author information

1
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: wooksung.kim@samsung.com.
3
Department of Internal Medicine, Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND:

Although current guidelines for pulmonary embolism (PE) treatment recommend surgical embolectomy when thrombolysis is contraindicated or has failed, their clinical outcomes rarely have been compared directly.

METHODS:

After excluding patients aged under 18 years and those with submassive or non-massive PE, 45 consecutive patients (median age, 68 years; 62% female; 31% experienced cardiac arrest before PE treatment onset; 33% had cancer diagnosis history; and 29% received extracorporeal membrane oxygenation [ECMO]) who underwent only thrombolysis (TL group; n=19) or surgical embolectomy (SE group; n=26, including 4 who had failed thrombolysis) for acute massive PE from 2000 to 2013 at Samsung Medical Center were enrolled to assess cardiac mortality as primary outcome.

RESULTS:

Median follow-up duration was 17.2 months. In the SE group, significantly higher proportions of patients had recent surgery and ECMO. Overall 30-day all-cause mortality rate was 24% (n=11), without significant difference between the SE (15%) and TL (37%) groups (P=0.098); however, cardiac mortality rate was significantly higher in the TL than SE group (Log rank P=0.023). TL was an independent multivariate predictor of cardiac death (P=0.03).

CONCLUSION:

In this small retrospective single center experience, surgical embolectomy is associated with lower cardiac mortality risk than thrombolysis, which might render it first-line treatment option for acute massive PE for patients without life-limiting comorbidities.

KEYWORDS:

Fibrinolysis; Pulmonary embolism; Shock; Surgical embolectomy

PMID:
26569368
DOI:
10.1016/j.ijcard.2015.10.223
[Indexed for MEDLINE]

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