Edelman J J, Okiwelu N, Anvardeen K, Joshi P, Murphy B, Sanders L H, Newman M A, Passage J
Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; The Baird Institute, Sydney, NSW, Australia.
Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Heart Lung Circ. 2016 Dec;25(12):1240-1244. doi: 10.1016/j.hlc.2016.03.010. Epub 2016 May 12.
Massive pulmonary embolism is a poorly tolerated condition. Treatment options in this condition include anticoagulation and primary reperfusion therapy - systemic thrombolysis, catheter based treatments or surgical embolectomy. There is little data on the relative efficacy of each treatment.
The preoperative characteristics and outcomes of patients referred for surgical embolectomy between 2000-2014 was reviewed. Echocardiography was performed in the majority of patients before and after surgery.
Thirty-seven patients underwent pulmonary embolectomy between 2000-2014. One patient died within 30 days, another before leaving hospital. All other patients were alive at the time of follow-up (survival 94.6% at median 36 months). Median ventilation time was 24hours. Median hospital length of stay was 10.5 days. There was echocardiographic evidence of severe right ventricular strain (increased size and decreased function) before surgery, which was significantly improved to within the normal range by discharge, and follow-up.
Surgical embolectomy is a safe procedure, with low mortality, improved postoperative right ventricular function and pulmonary pressure, and good long-term outcome. Early relief of a large proportion of the clot burden can be life-saving. There should be consideration for its use as an initial treatment strategy in patients with massive or submassive pulmonary embolus with a large burden of proximal clot. A multidisciplinary approach for the treatment of these patients is required.
大面积肺栓塞是一种耐受性较差的疾病。该疾病的治疗选择包括抗凝和初始再灌注治疗——全身溶栓、基于导管的治疗或外科血栓切除术。关于每种治疗的相对疗效的数据很少。
回顾了2000年至2014年间接受外科血栓切除术患者的术前特征和结局。大多数患者在手术前后均进行了超声心动图检查。
2000年至2014年间有37例患者接受了肺血栓切除术。1例患者在30天内死亡，另1例在出院前死亡。所有其他患者在随访时均存活（中位随访36个月时生存率为94.6%）。中位通气时间为24小时。中位住院时间为10.5天。术前有超声心动图证据显示严重右心室劳损（大小增加和功能降低），出院时及随访时明显改善至正常范围内。
外科血栓切除术是一种安全的手术，死亡率低，术后右心室功能和肺动脉压改善，长期预后良好。早期减轻大部分血栓负荷可挽救生命。对于大面积或次大面积肺栓塞且近端血栓负荷大的患者，应考虑将其作为初始治疗策略。治疗这些患者需要多学科方法。
