1371 Department of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA.
7547 St. Louis University School of Medicine, MO, USA.
Innovations (Phila). 2020 Mar/Apr;15(2):180-184. doi: 10.1177/1556984520909803.
The endpoint in emergent management of acute massive pulmonary embolism (PE) has traditionally been with embolectomy through standard median sternotomy. This approach is limited in both exposure and concomitant functional morbidity associated with sternotomy. Herein we describe a novel minimally invasive, thoracoscopically assisted approach to pulmonary embolectomy. This utilizes a small 5-cm left parasternal thoracotomy and femoral cardiopulmonary bypass to conduct thoracoscopically assisted surgical pulmonary embolectomy. This novel minimally invasive approach has been developed and successfully utilized in 3 patients with massive PE at our institution. The assistance of the thoracoscope allowed for complete visualization and clot extraction of the main and segmental pulmonary arteries bilaterally. The use of a non-sternotomy approach sped both functional and pulmonary recovery times and decreased length of stay. These initial data suggest that non-sternotomy minimally invasive surgical pulmonary embolectomy with thoracoscopic assistance is a feasible and safe approach for acute massive PE that may result in enhanced recovery times and decreased hospital length of stay.
急性大面积肺栓塞（PE）的紧急处理终点传统上是通过标准正中胸骨切开术进行血栓切除术。这种方法在暴露度和与胸骨切开术相关的伴随功能发病率方面都受到限制。在此，我们描述了一种新的微创、胸腔镜辅助肺血栓切除术方法。这利用了一个 5 厘米小的左胸骨旁胸腔切开术和股心肺旁路来进行胸腔镜辅助手术肺血栓切除术。这种新的微创方法已在我们机构的 3 例大面积 PE 患者中得到开发和成功应用。胸腔镜的辅助作用使得双侧主肺动脉和段肺动脉的完全可视化和血栓清除成为可能。非胸骨切开术方法的使用加快了功能和肺恢复时间，并缩短了住院时间。这些初步数据表明，胸腔镜辅助非胸骨切开术微创外科肺血栓切除术是一种可行且安全的急性大面积 PE 治疗方法，可能会导致恢复时间更快和住院时间缩短。
