Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Faculty of Medicine, University of Chile, Santiago, Chile.
Ann Thorac Surg. 2020 Sep;110(3):1072-1080. doi: 10.1016/j.athoracsur.2020.01.075. Epub 2020 Mar 6.
Acute pulmonary embolism (PE) is associated with significant mortality. Surgical embolectomy is a viable treatment option; however, it remains controversial as a result of variable outcomes. This review investigates patient outcomes after surgical embolectomy for acute PE.
An electronic search was performed to identify articles reporting surgical embolectomy for treatment of PE. 32 studies were included comprising 936 patients. Demographic, perioperative, and outcome data were extracted and pooled for systematic review.
Mean patient age was 56.3 years (95% confidence interval [CI], 52.5, 60.1), and 50% were male (95% CI, 46, 55); 82% had right ventricular dysfunction (95% CI, 62, 93), 80% (95% CI, 67, 89) had unstable hemodynamics, and 9% (95% CI, 5, 16) experienced cardiac arrest. Massive PE and submassive PE were present in 83% (95% CI, 43, 97)] and 13% (95% CI, 2, 56) of patients, respectively. Before embolectomy, 33% of patients (95% CI, 14, 60) underwent systemic thrombolysis, and 14% (95% CI, 8, 24) underwent catheter embolectomy. Preoperatively, 47% of patients were ventilated (95% CI, 26; 70), and 36% had percutaneous cardiopulmonary support (95% CI, 11, 71). Mean operative time and mean cardiopulmonary bypass time were 170 minutes (95% CI, 101, 239) and 56 minutes (95% CI, 42, 70), respectively. Intraoperative mortality was 4% (95% CI, 2, 8). Mean hospital and intensive care unit stay were 10 days (95% CI, 6, 14) and 2 days (95% CI, 1, 3), respectively. Mean postoperative systolic pulmonary artery pressure (sPAP) was significantly decreased from the preoperative period (sPAP 57.8, mm Hg; 95% CI, 53, 62.7) to the postoperative period (sPAP, 31.3 mm Hg; 24.9, 37.8); P < .01). In-hospital mortality was 16% (95% CI, 12, 21). Overall survival at 5 years was 73% (95% CI, 64, 81).
Surgical embolectomy is an acceptable treatment option with favorable outcomes.
急性肺栓塞（PE）与显著的死亡率相关。外科血栓切除术是一种可行的治疗选择；然而，由于结果的可变性，它仍然存在争议。本综述调查了外科血栓切除术治疗急性 PE 的患者结局。
进行了电子检索，以确定报告外科血栓切除术治疗 PE 的文章。纳入了 32 项研究，共纳入 936 名患者。提取并汇总了人口统计学、围手术期和结局数据，以进行系统评价。
患者平均年龄为 56.3 岁（95%置信区间 [CI]，52.5，60.1），50%为男性（95%CI，46，55）；82%存在右心室功能障碍（95%CI，62，93），80%存在不稳定的血流动力学（95%CI，67，89），9%发生心脏骤停（95%CI，5，16）。大块 PE 和次大块 PE 分别见于 83%（95%CI，43，97）和 13%（95%CI，2，56）的患者。在血栓切除术之前，33%的患者（95%CI，14，60）接受了全身溶栓治疗，14%的患者（95%CI，8，24）接受了导管血栓切除术。术前，47%的患者（95%CI，26；70）接受了通气，36%的患者（95%CI，11，71）接受了经皮心肺支持。手术时间的平均值和体外循环时间的平均值分别为 170 分钟（95%CI，101，239）和 56 分钟（95%CI，42，70）。术中死亡率为 4%（95%CI，2，8）。住院和重症监护病房的平均住院时间分别为 10 天（95%CI，6，14）和 2 天（95%CI，1，3）。术后收缩期肺动脉压（sPAP）明显低于术前（sPAP57.8mmHg；95%CI，53，62.7mmHg）（P<0.01）。住院期间死亡率为 16%（95%CI，12，21）。5 年总体生存率为 73%（95%CI，64，81）。
外科血栓切除术是一种可行的治疗选择，具有良好的结果。
