Department of Surgery, Division of Cardiothoracic Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA.
School of Medicine, American University of Beirut, Beirut, Lebanon.
J Card Surg. 2021 Apr;36(4):1258-1263. doi: 10.1111/jocs.15357. Epub 2021 Feb 3.
The endpoint in emergent management of acute massive pulmonary embolism (PE) has traditionally been with embolectomy through a standard median sternotomy. This approach is limited in both exposure and concomitant functional morbidity associated with sternotomy. In a previous publication, we described a novel minimally invasive, thoracoscopically assisted approach to pulmonary embolectomy. This approach utilized a small 5-cm left upper parasternal thoracotomy and femoral cardiopulmonary bypass to conduct thoracoscopically assisted surgical pulmonary embolectomy. The first publication featured three patients that had a massive pulmonary embolus that was treated with minimally invasive pulmonary embolectomy, and the initial data was positive and suggested that this approach is safe and feasible. We now broaden our experience with another two patients who underwent this approach, and highlight a number of technical and management modifications that have been made to optimize the procedure. These lessons learned will ideally benefit future surgeons as this approach is more heavily implemented in practice.
急性大面积肺栓塞（PE）的紧急处理的终点传统上是通过标准的正中胸骨切开术进行血栓切除术。这种方法在暴露程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。在之前的一篇出版物中，我们描述了一种新的微创、胸腔镜辅助肺血栓切除术方法。该方法采用小的 5cm 左胸骨旁上胸切开术和股心肺旁路来进行胸腔镜辅助外科肺血栓切除术。第一篇出版物介绍了三位患有巨大肺栓塞的患者，他们接受了微创肺血栓切除术治疗，最初的数据是积极的，并表明这种方法是安全可行的。我们现在扩大了另外两名接受这种方法治疗的患者的经验，并强调了已经进行了一些技术和管理上的修改，以优化该手术。随着这种方法在实践中更广泛地应用，这些经验教训将为未来的外科医生带来益处。
