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Abstract：
BACKGROUND: Acute pulmonary embolism (PE) is one of the most critical cardiovascular diseases. PE treatment ranges from anticoagulation, and systemic thrombolysis to surgical embolectomy and catheter embolectomy. Surgical pulmonary embolectmy (SPE) indications and outcomes are still controversial. Although there have been more favourable SPE reports over the past decades, SPE has not yet been considered broadly as an initial PE therapy and is still considered as a reserve or rescue treatment for acute massive PE when systemic thrombolysis fails. This study aimed to evaluate the early and midterm outcomes of SPE, which was a first-line therapy for acute central major PE in one Chinese single centre.
METHODS: A retrospective review of patients who underwent SPE for acute PE was conducted.Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular function.
RESULTS: Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2 ± 48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping. Ventilatory support time was 78 h (range, 40-336 h), intensive care unit stay was 7 days (range, 3-13 days), and hospital stay was 16 days (range, 12-23 days). Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients\' right ventricle function improved postoperatively in follow-ups.There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively.
CONCLUSIONS: SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups. SPE should play the same role as ST in algorithmic acute PE treatment.
METHODS: A retrospective review of patients who underwent SPE for acute PE was conducted.Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular function.
RESULTS: Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2 ± 48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping. Ventilatory support time was 78 h (range, 40-336 h), intensive care unit stay was 7 days (range, 3-13 days), and hospital stay was 16 days (range, 12-23 days). Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients\' right ventricle function improved postoperatively in follow-ups.There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively.
CONCLUSIONS: SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups. SPE should play the same role as ST in algorithmic acute PE treatment.
摘要：
背景：急性肺栓塞（PE）是最严重的心血管疾病之一。PE治疗范围从抗凝，和全身溶栓手术取栓和导管取栓。手术肺栓塞（SPE）的适应症和结果仍然存在争议。尽管在过去的几十年里有更有利的SPE报告，SPE尚未被广泛视为初始PE治疗，并且在全身溶栓失败时仍被视为急性大量PE的储备或抢救治疗。本研究旨在评估SPE的早期和中期结果，这是一个中国单一中心的急性中央型主要PE的一线治疗。
方法：对因急性PE而接受SPE的患者进行回顾性分析。排除患有慢性血栓或接受血栓内膜切除术的患者。对发病率和死亡率的SPE危险因素进行了综述，和超声心动图检查进行随访研究以获得右心室功能。
结果：总体而言，纳入41例患者；17例（41.5%）患有块状PE，24人（58.5%）的PE很高。平均体外循环时间为103.2±48.9min,10例患者(24.4%)接受了无主动脉阻断的手术。通气支持时间为78h(范围，40-336小时)，重症监护病房住院7天(范围，3-13天),住院时间为16天(范围，12-23天）。手术死亡率发生在3例大面积PE患者中，亚肿块型PE患者没有死亡。总体SPE死亡率为7.31%(3/41)。如果排除2例全身溶栓病例，SPE死亡率低（2.56%，1/39),尽管术前心脏骤停2例。术后随访患者右心室功能改善。随访中没有与复发性PE和慢性肺动脉高压相关的死亡，尽管有3例患者死于脑颅内出血，胃癌,和1年的脑癌，3年,术后8年，分别。
结论：SPE在选定的大面积和亚大面积急性PE患者中作为一线治疗，其死亡率较低。在随访中也观察到了右心室功能的良好结果。SPE在算法急性PE治疗中应与ST相同。
方法：对因急性PE而接受SPE的患者进行回顾性分析。排除患有慢性血栓或接受血栓内膜切除术的患者。对发病率和死亡率的SPE危险因素进行了综述，和超声心动图检查进行随访研究以获得右心室功能。
结果：总体而言，纳入41例患者；17例（41.5%）患有块状PE，24人（58.5%）的PE很高。平均体外循环时间为103.2±48.9min,10例患者(24.4%)接受了无主动脉阻断的手术。通气支持时间为78h(范围，40-336小时)，重症监护病房住院7天(范围，3-13天),住院时间为16天(范围，12-23天）。手术死亡率发生在3例大面积PE患者中，亚肿块型PE患者没有死亡。总体SPE死亡率为7.31%(3/41)。如果排除2例全身溶栓病例，SPE死亡率低（2.56%，1/39),尽管术前心脏骤停2例。术后随访患者右心室功能改善。随访中没有与复发性PE和慢性肺动脉高压相关的死亡，尽管有3例患者死于脑颅内出血，胃癌,和1年的脑癌，3年,术后8年，分别。
结论：SPE在选定的大面积和亚大面积急性PE患者中作为一线治疗，其死亡率较低。在随访中也观察到了右心室功能的良好结果。SPE在算法急性PE治疗中应与ST相同。
