Decision making in the surgical treatment of massive pulmonary embolism.

Pulmonary embolectomy in the treatment of acute massive pulmonary embolism (PE) is the subject of considerable controversy with regard to indication, technique of embolectomy and perioperative management. Since 1968 50 patients have undergone surgery for massive PE in our unit. Inflow occlusion technique and cardiopulmonary bypass were used in 33 and 17 patients, respectively. The overall operative mortality was 46%. Univariate analysis disclosed age (< 60 vs > 60), preoperative hemodynamics (cardiogenic shock vs cardiac arrest), location of emboli (peripheral vs central), duration of symptoms (hours vs days vs weeks) and number of episodes (first episode vs recurrent pulmonary emboli) as predictive factors of the post-operative outcome. The results of the retrospective analysis show that pulmonary embolectomy remains an acceptable procedure in patients with acute massive pulmonary emboli who are in refractory cardiogenic shock or who need intermittent resuscitation.