Meyer G, Tamisier D, Sors H, Stern M, Vouhé P, Makowski S, Neveux J Y, Leca F, Even P
Department of Cardiothoracic Surgery, Laennec Hospital, Paris, France.
Ann Thorac Surg. 1991 Feb;51(2):232-6. doi: 10.1016/0003-4975(91)90792-o.
Between 1968 and 1988, 96 consecutive patients with acute massive pulmonary embolism underwent pulmonary embolectomy under cardiopulmonary bypass. The operative mortality rate was 37.5%. We analyzed 12 clinical and hemodynamic variables by univariate and multivariate analyses to assess the predictive factors of postoperative outcome. Multivariate analysis disclosed that cardiac arrest and associated cardiopulmonary disease were independent predictors of operative death. Long-term follow-up (range, 2 to 144 months; mean, 56 months) information was available for 55 of the 60 discharged patients: 6 had died, and 5 complained of persistent mild or severe exertional dyspnea (New York Heart Association class II). These results help assess the preoperative risk in patients undergoing pulmonary embolectomy. They also show that, in the few patients who do not benefit from optimal medical therapy, pulmonary embolectomy remains an acceptable procedure in view of the long-term results.
1968年至1988年间，96例连续性急性大面积肺栓塞患者在体外循环下行肺动脉血栓切除术。手术死亡率为37.5%。我们通过单因素和多因素分析对12项临床和血流动力学变量进行分析，以评估术后结果的预测因素。多因素分析显示，心脏骤停和相关心肺疾病是手术死亡的独立预测因素。60例出院患者中有55例获得了长期随访（范围为2至144个月；平均56个月）：6例死亡，5例主诉持续存在轻度或重度劳力性呼吸困难（纽约心脏病协会II级）。这些结果有助于评估接受肺动脉血栓切除术患者的术前风险。它们还表明，对于少数未从最佳药物治疗中获益的患者，鉴于长期结果，肺动脉血栓切除术仍是一种可接受的手术。
