What is the place of pulmonary embolectomy today?

From 1.1970 to 31.12.1989, 134 patients with pulmonary embolism were treated by pulmonary embolectomy (74 women and 60 men) of mean age 55 years (23-78 years); 93 (69%) of these patients developed embolism during the postoperative period following surgery for another condition. In 12 cases the embolectomy was performed without circulatory assistance by a modified Trendelenburg operation after an average delay time of 2 hours. In 122 cases, extracorporeal circulation (ECC) was used, preceded in 64 cases, by a femoral-femoral bypass (the average delay interval of operation being 16.9 hours). At operation, 23 patients were in complete circulatory failure needing external cardiac massage, 34 were in cardiogenic shock with systolic arterial pressures (SAP) less than 60 mmHg, 42 maintained their arterial pressure between 60 and 100 mmHg, and only 35 were seen with SAP higher than 100 mmHg under vasopressive drugs. No haemodynamic and angiographic investigations could be undertaken in 31 patients because of their dramatic clinical state. In the other 103 patients who had invasive angiographic investigations performed the pulmonary bed was obstructed from 65% to 90% (mean 79.4%) according to Miller's index. The mean arterial pulmonary pressure was 51.2 mmHg. The survival rate at the 30th postoperative day showed 113 patients were alive (84.3%) with 7 among the 12 operated by the Trendelenburg's modified method and 106 among the 122 operated under ECC. The main causes of the 21 deaths were: peroperative 8, neurological 4, cardiac 4, respiratory 1, recurrent embolism 1, acute thrombosis of the IVC 1. Our results of pulmonary embolectomy can be compared favorably to those obtained by thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)