Key result
Surgical embolectomy for massive PE carries ~27% operative mortality, higher with preoperative cardiac massage.
Why the study?
Surgical treatment issues and outcomes of pulmonary thromboembolectomy under cardiopulmonary bypass for acute massive pulmonary thromboembolism were not well characterized.
Observational (n=15)
No
Pulmonary thromboembolectomy under cardiopulmonary bypass is an effective treatment for acute massive pulmonary thromboembolism, with excellent long-term outcomes in survivors, though preoperative cardiac arrest requiring massage is a strong predictor of mortality.
May support surgical embolectomy in acute PE without preoperative CPR; leaves open need for prospective trials versus contemporary therapies.
急性肺血栓塞栓症に対し体外循環下血栓塞栓摘除術を行った15例（男5例，平均年齢61±16歳）を対象に，外科治療上の問題点を検討した．手術成績（死亡率26.7％）より，I群：耐術群（11例），II群：死亡群（4例）に分けた．両群間で年齢，性比，術前ショック合併率，休外循環時間に差はなかったが，術前心臓マッサージ施行率はII群で有意に高かった（0％：75％，p<0.01）．死亡原因は3例が低心拍出症候群，1例が多臓器不全であった．耐術群全例が追跡可能（平均追跡期間4年5ヵ月：5ヵ月～10年10ヵ月）で，遠隔死亡は術後10年10ヵ月目の悪性リンパ腫による1例のみであった．残り10例の現在のNYHA心機能分類はI度9例，Ⅱ度1例であった．1例で術後11ヵ月目に無症状の肺梗塞が発生した．術前に心臓マッサージを受けなかった症例での手術成績および耐術例での遠隔成組は良好で，急性肺血栓塞栓症に対する体外循環下血栓塞栓摘除術は有用な治療手段である．
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Shimokawa et al. (2001) conducted an observational in Acute massive pulmonary thromboembolism (n=15). Pulmonary thromboembolectomy with cardiopulmonary bypass was evaluated on Operative mortality. Pulmonary thromboembolectomy with cardiopulmonary bypass for acute massive pulmonary thromboembolism had an operative mortality of 26.7%, with significantly higher mortality in patients requiring preoperative cardiac massage.
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