Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Ann Thorac Surg. 2012 Sep;94(3):785-91. doi: 10.1016/j.athoracsur.2012.03.101. Epub 2012 Jun 13.
Acute high-risk pulmonary embolism is a life-threatening condition with high early mortality rates resulting from acute right ventricular failure and cardiogenic shock. We retrospectively analyzed the outcomes of surgical embolectomy among patients with circulatory collapse.
Between July 2000 and September 2011, 24 consecutive patients (17 women and 7 men; mean age, 59.9±17.2 years) underwent emergency surgical embolectomy to treat acute pulmonary embolism with circulatory collapse. Nineteen (79.2%) patients were in cardiogenic shock, and 16 (66.7%) patients received preoperative percutaneous cardiopulmonary support. Eleven (45.8%) patients were in cardiac arrest. The preoperative pulmonary artery obstruction index was 76.9%±16.4% (median, 88.9%; range, 44.4%-88.9%). The indications for surgical intervention were cardiogenic shock (n=16 [66.7%]), failed medical therapy or catheter embolectomy (n=4 [16.7%]), or contraindication for thrombolysis (n=4 [16.7%]). Follow-up was 100% complete with a mean of 6.8±3.9 years (median, 5.6 years).
The in-hospital mortality rate was 12.5% (n=3). One patient underwent a repeated embolectomy on postoperative day 6. The postoperative course was complicated by cerebral infarction and by mediastinitis in 1 patient each. The 5-year cumulative survival rate was 87.5%±6.8%. Mean right ventricular pressure significantly decreased from 66.9 to 28.5 mm Hg among the survivors.
Surgical pulmonary embolectomy is an excellent approach to treating acute pulmonary embolism with circulatory collapse. Providing immediate percutaneous cardiopulmonary support to patients with cardiogenic shock could help to resuscitate and stabilize cardiopulmonary function and allow for a good outcome of pulmonary embolectomy.
急性高危肺栓塞是一种危及生命的病症，其早期死亡率较高，原因是急性右心室衰竭和心源性休克。我们回顾性分析了循环衰竭患者行外科取栓术的结果。
2000 年 7 月至 2011 年 9 月，24 例连续患者（17 名女性和 7 名男性；平均年龄 59.9±17.2 岁）因急性肺栓塞伴循环衰竭而行紧急外科取栓术。19 例（79.2%）患者处于心源性休克状态，16 例（66.7%）患者术前接受了经皮心肺支持。11 例（45.8%）患者发生心脏骤停。术前肺动脉阻塞指数为 76.9%±16.4%（中位数 88.9%；范围 44.4%-88.9%）。手术干预的适应证为心源性休克（16 例，66.7%）、药物治疗或导管取栓失败（4 例，16.7%）或溶栓禁忌（4 例，16.7%）。100%的患者完成了随访，平均随访时间为 6.8±3.9 年（中位数为 5.6 年）。
院内死亡率为 12.5%（3 例）。1 例患者术后第 6 天行重复取栓术。术后并发脑梗死和纵隔炎各 1 例。5 年累积生存率为 87.5%±6.8%。幸存者的右心室压从 66.9mmHg 显著降至 28.5mmHg。
外科肺血栓切除术是治疗循环衰竭急性肺栓塞的一种极好方法。对心源性休克患者立即行经皮心肺支持有助于复苏和稳定心肺功能，并可获得良好的肺血栓切除术结果。
