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Ann Thorac Surg 2004;77:819-823
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Open pulmonary embolectomy for treatment of major pulmonary embolism

Kiran Yalamanchili, MBBSc, Arlen G. Fleisher, MDa*, Stuart G. Lehrman, MDb, Howard I. Axelrod, MDa, Rocco J. Lafaro, MDa, Mohan R. Sarabu, MDa, Elias A. Zias, MDa, Richard A. Moggio, MDa

a Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
b Pulmonary and Critical Care Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
c Internal Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York, USA

Accepted for publication August 15, 2003.

* Address reprint requests to Dr Fleisher, Cardiothoracic Surgery, Westchester Medical Center, Macy Pavilion, Valhalla, NY 10595, USA
e-mail: fleishera{at}wcmc.com

BACKGROUND: Inadequate data exist regarding the management of acute major pulmonary embolism. Various modalities that are used, including thrombolytics and embolectomy, have not been shown to conclusively improve mortality when compared to heparin. In the past, open pulmonary embolectomy was reserved for patients with severe hemodynamic instability because of its high mortality rate. Our objective was to analyze our experience with early embolectomy as an alternative for the treatment of major pulmonary embolism.

METHODS: A retrospective review of charts of all patients undergoing pulmonary embolectomy at our institution over the last two years was performed. Patients were followed until their discharge from hospital.

RESULTS: There were 13 patients (7 women and 6 men). Four had massive and 9 had submassive pulmonary embolism. There was one mortality. Postoperative echocardiography showed no evidence of pulmonary hypertension in 7.

CONCLUSIONS: Open pulmonary embolectomy can be performed in patients with major pulmonary embolism with minimal mortality and morbidity. It may prevent the development of chronic thromboembolic pulmonary hypertension and should be a part of the algorithm in the treatment of major pulmonary embolism.




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