Department of Cardiovascular Surgery, Union Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, China.
Fujian Medical University, Fuzhou, 350001, Fujian, China.
J Cardiothorac Surg. 2020 Oct 21;15(1):321. doi: 10.1186/s13019-020-01364-z.
Acute pulmonary embolism (PE) is one of the most critical cardiovascular diseases. PE treatment ranges from anticoagulation, and systemic thrombolysis to surgical embolectomy and catheter embolectomy. Surgical pulmonary embolectmy (SPE) indications and outcomes are still controversial. Although there have been more favourable SPE reports over the past decades, SPE has not yet been considered broadly as an initial PE therapy and is still considered as a reserve or rescue treatment for acute massive PE when systemic thrombolysis fails. This study aimed to evaluate the early and midterm outcomes of SPE, which was a first-line therapy for acute central major PE in one Chinese single centre.
A retrospective review of patients who underwent SPE for acute PE was conducted.Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular function.
Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2 ± 48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping. Ventilatory support time was 78 h (range, 40-336 h), intensive care unit stay was 7 days (range, 3-13 days), and hospital stay was 16 days (range, 12-23 days). Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients' right ventricle function improved postoperatively in follow-ups.There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively.
SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups. SPE should play the same role as ST in algorithmic acute PE treatment.
急性肺栓塞（PE）是最危急的心血管疾病之一。PE 的治疗范围从抗凝、全身溶栓到外科取栓和导管取栓。外科肺动脉血栓切除术（SPE）的适应证和结果仍存在争议。尽管在过去几十年中，SPE 的报告结果更为有利，但SPE 尚未被广泛认为是急性大面积 PE 的初始治疗方法，当全身溶栓失败时，SPE 仍被视为急性大块 PE 的储备或抢救治疗。本研究旨在评估 SPE 的早期和中期结果，SPE 是中国一家单一中心治疗急性中央型大块 PE 的一线治疗方法。
对接受 SPE 治疗的急性 PE 患者进行回顾性研究。排除有慢性血栓或接受血栓内膜切除术的患者。回顾 SPE 治疗发病率和死亡率的危险因素，并进行超声心动图检查以评估右心室功能。
共纳入 41 例患者；17 例（41.5%）为亚大块 PE，24 例（58.5%）为大块 PE。体外循环时间平均为 103.2±48.9 分钟，10 例（24.4%）患者在无主动脉阻断的情况下进行了手术。通气支持时间为 78 小时（范围：40-336 小时），重症监护病房住院时间为 7 天（范围：3-13 天），住院时间为 16 天（范围：12-23 天）。3 例大块 PE 患者发生手术死亡率，亚大块 PE 患者无死亡。整体 SPE 死亡率为 7.31%（3/41）。如果排除 2 例全身溶栓病例，SPE 死亡率较低（2.56%，1/39），尽管术前有 2 例心脏骤停。患者的右心室功能在随访中术后得到改善。随访中未发生与复发性 PE 和慢性肺动脉高压相关的死亡，但有 3 例患者分别在术后 1、3 和 8 年死于颅内出血、胃癌和脑癌。
在选择的大块和亚大块急性 PE 患者中，SPE 作为一线治疗时死亡率较低。在随访中也观察到右心室功能的良好结果。SPE 应在急性 PE 治疗算法中发挥与 ST 相同的作用。
