Rathore Kaushalendra Singh, Weightman William, Passage Jurgen, Joshi Pragnesh, Sanders Lucas, Newman Mark
Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia.
Department of Cardiac Anaesthesia, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia.
J Card Surg. 2020 Jul;35(7):1531-1538. doi: 10.1111/jocs.14652. Epub 2020 Jun 29.
Surgical pulmonary embolectomy (SPE) has been around since the early days of cardiac surgery. But with the increase in thrombolytic and intervention options, indications of SPE have been limited. Literature suggests that risk stratification has been a key step in getting good results. We are analyzing serum lactate levels for risk stratification in massive and submassive pulmonary embolism (PE).
This study is a retrospective analysis of 82 cases that underwent SPE between January 1997 and January 2020. Patients were divided into two groups stratified by venous serum lactate levels on the first admission (Group I: normolactatemia <2 mmol/L, Group II: hyperlactatemia, >2 mmol/L). Primary endpoints were all-cause in-hospital mortality and secondary endpoints were cardiopulmonary bypass time, extracorporeal membrane oxygenator (ECMO) insertion, low cardiac output, blood product use, and right ventricular functions in the follow-up.
Our study had an overall follow-up of 23 years with a median of 3.18 years. Overall, the in-hospital mortality rate was 8.54%. Group II had a higher mortality rate (P = .015) and morbidity incidences like cardiopulmonary bypass time (P = .008), ECMO insertion (P = .036), and open chest after surgery (P = .015). Although 5-year survival was better in group I a compared to group II (81%, 95% CI, 69%-93% vs 65%, 95% CI, 46%-84%), the log rank test showed no statistical survival difference among both groups on long-term follow-up.
Long term survival after SPE is good and these results can further be improved by proper PE risk stratification. Alongside computed tomography and echocardiography, the importance of biomarkers like serum lactate can be explored in the PE management algorithm.
外科肺动脉血栓切除术（SPE）自心脏外科手术早期就已存在。但随着溶栓和介入治疗选择的增加，SPE的适应证受到了限制。文献表明，风险分层是取得良好疗效的关键步骤。我们正在分析血清乳酸水平，以对大面积和次大面积肺栓塞（PE）进行风险分层。
本研究是对1997年1月至2020年1月期间接受SPE的82例患者进行的回顾性分析。患者根据首次入院时的静脉血清乳酸水平分为两组（I组：正常乳酸血症<2 mmol/L，II组：高乳酸血症，>2 mmol/L）。主要终点是全因住院死亡率，次要终点是体外循环时间、体外膜肺氧合（ECMO）置入、低心输出量、血液制品使用以及随访中的右心室功能。
我们的研究总随访时间为23年，中位数为3.18年。总体而言，住院死亡率为8.54%。II组的死亡率更高（P = 0.015），且在体外循环时间（P = 0.008）、ECMO置入（P = 0.036）和术后开胸（P = 0.015）等发病率方面也更高。虽然I组的5年生存率优于II组（81%，95%CI，69%-93% vs 65%，95%CI，46%-84%），但对数秩检验显示两组在长期随访中的生存差异无统计学意义。
SPE后的长期生存率良好，通过适当的PE风险分层可进一步改善这些结果。除了计算机断层扫描和超声心动图外，还可在PE管理算法中探索血清乳酸等生物标志物的重要性。
