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

Published

Journal Article

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 data set. We 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 to 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 1 SPE (overall mean, 0.42 ± 1.03 cases • year-1 • center-1). A total of 1,075 eligible SPE were identified (NCS = 719, CS = 203, CS/CA = 153). Median age was 57 years (interquartile range, 45 to 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, preoperative 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.

Full Text

Duke Authors

Cited Authors

  • Kon, ZN; Pasrija, C; Bittle, GJ; Vemulapalli, S; Grau-Sepulveda, MV; Matsouaka, R; Deatrick, KB; Taylor, BS; Gammie, JS; Griffith, BP

Published Date

  • May 2019

Published In

Volume / Issue

  • 107 / 5

Start / End Page

  • 1401 - 1408

PubMed ID

  • 30476479

Pubmed Central ID

  • 30476479

Electronic International Standard Serial Number (EISSN)

  • 1552-6259

Digital Object Identifier (DOI)

  • 10.1016/j.athoracsur.2018.10.035

Language

  • eng

Conference Location

  • Netherlands