What is the clinical evidence from this study?

Study design: Observational. Population: Acute severe pulmonary embolism (n=16). Intervention: Surgical pulmonary embolectomy. Primary outcome: In-hospital mortality.

What does this research mean for the field?

Early surgical pulmonary embolectomy achieves acceptable outcomes with an 11% in-hospital mortality in emergent cases with right ventricular dysfunction, whereas salvage embolectomy results in an 85% mortality rate. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

To evaluate the clinical outcomes of surgical pulmonary embolectomy in acute massive pulmonary embolism and assess the impact of surgical timing on patient survival.

February 9, 2010Journal of Cardiac SurgeryOpen Access

Pulmonary Embolectomy: Recommendation for Early Surgical Intervention

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Key result

Surgical pulmonary embolectomy for massive PE carries ~43% in-hospital mortality, driven primarily by salvage cases.

n=16

Why the study?

There is no consensus on the management of acute severe pulmonary embolism despite efforts to improve outcomes.

What are the outcomes of early versus salvage surgical pulmonary embolectomy in patients with massive pulmonary embolism?

Population

16 consecutive patients with massive acute pulmonary embolism, mean age 45 +/- 17 years, 56% male

Comparison

Urgent/emergent surgical pulmonary embolectomy vs salvage surgical pulmonary embolectomy

Design

Observational case series

Follow-up

Mean 48 +/- 38 months

Authors

ECEnisa M. CarvalhoUniversity of Miami FMFrancisco Igor B. MacedoHackensack University Medical Center APAnthony L. PanosUniversity of Iowa Hospitals and Clinics

Discussion

Member takes

Implication

Early embolectomy may benefit stable PE with RV dysfunction; leaves open need for RCTs versus medical therapy.

Key Points

To evaluate the clinical outcomes of surgical pulmonary embolectomy in acute massive pulmonary embolism and assess the impact of surgical timing on patient survival.
Retrospective review of 16 consecutive patients (mean age 45 ± 17 years; 56% male) undergoing surgical pulmonary embolectomy from May 2000 to June 2009 at a single center.
Patients were classified into urgent/emergent interventions (n=9) or salvage operations performed during hemodynamic collapse under active cardiopulmonary resuscitation (n=7).
Overall in-hospital mortality was 43% (7/16), occurring in 11% (1/9) of urgent/emergent procedures compared to 85% (6/7) of salvage procedures.
Preoperative moderate to severe right ventricular dilation or dysfunction occurred in 77% (7/9) of nonsalvage patients.
Mean cardiopulmonary bypass time was 43 ± 41 minutes, with a mean post-surgical follow-up duration of 48 ± 38 months.

Study Design

Type

Observational (n=16)

Multicenter

Structured PICO

What are the outcomes of early versus salvage surgical pulmonary embolectomy in patients with massive pulmonary embolism?

Population

16 consecutive patients with massive acute pulmonary embolism undergoing surgical pulmonary embolectomy, followed for a mean of 48 months.

Exposure

Surgical pulmonary embolectomy (urgent/emergent or salvage)

Outcome

In-hospital mortalityhard clinical

Surgical pulmonary embolectomy has favorable outcomes when performed early in patients with RV dysfunction, but dismal results in salvage situations.

Cite This Study

Carvalho et al. (2010) conducted an observational in Acute severe pulmonary embolism (n=16). Surgical pulmonary embolectomy was evaluated on In-hospital mortality. Surgical pulmonary embolectomy for massive pulmonary embolism had an overall in-hospital mortality of 43%, with 11% mortality in emergent cases and 85% in salvage operations.

synapsesocial.com/papers/6aaa53c237a4daa60571c922 https://doi.org/10.1111/j.1540-8191.2009.00986.x

Topics

Pulmonary embolism

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Pulmonary Embolectomy: Recommendation for Early Surgical Intervention

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Pulmonary Embolectomy: Recommendation for Early Surgical Intervention

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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Topics

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