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Rahouma M, Al-Thani S, Salem H, Mahmoud A, Khairallah S, Shenouda D, Sultan B, Khalil L, Alomari M, Ali M, Makey IA, Haney JC, Mick S, El-Sayed Ahmed MM. The Outcomes of Surgical Pulmonary Embolectomy for Pulmonary Embolism: A Meta-Analysis. J Clin Med 2024; 13:4076. [PMID: 39064116 PMCID: PMC11278425 DOI: 10.3390/jcm13144076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/04/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Objectives: The purpose of this study is to assess the efficacy, short- and long-term cardiovascular and non-cardiovascular mortalities and postoperative morbidities of surgical pulmonary embolectomy (SPE) for patients with massive or submassive pulmonary embolism. Methods: A comprehensive literature review was performed to identify articles reporting SPE for pulmonary embolism. The outcomes included in-hospital and long-term mortality in addition to postoperative morbidities. The random effect inverse variance method was used. Cumulative meta-analysis, leave-one-out sensitivity analysis, subgroup analysis and meta-regression were performed. Results: Among the 1949 searched studies in our systematic literature search, 78 studies met our inclusion criteria, including 6859 cases. The mean age ranged from 42 to 65 years. The percentage of males ranged from 25.6% to 86.7%. The median rate of preoperative cardiac arrest was 27.6%. The percentage of contraindications to preoperative systemic thrombolysis was 30.4%. The preoperative systemic thrombolysis use was 11.5%. The in-hospital mortality was estimated to be 21.96% (95% CI: 19.21-24.98); in-hospital mortality from direct cardiovascular causes was estimated to be 16.05% (95% CI: 12.95-19.73). With a weighted median follow-up of 3.05 years, the late cardiovascular and non-cardiovascular mortality incidence rates were 0.39 and 0.90 per person-year, respectively. The incidence of pulmonary bleeding, gastrointestinal bleeding, surgical site bleeding, non-surgical site bleeding and wound complications was 0.62%, 4.70%, 4.84%, 5.80% and 7.2%, respectively. Cumulative meta-analysis showed a decline in hospital mortality for SPE from 42.86% in 1965 to 20.56% in 2024. Meta-regression revealed that the publication year and male sex were associated with lower in-hospital mortality, while preoperative cardiac arrest, the need for inotropes or vasopressors and preoperative mechanical ventilation were associated with higher in-hospital mortality. Conclusions: This study demonstrates acceptable perioperative mortality rates and late cardiovascular and non-cardiovascular mortality in patients who undergo SPE for massive or submassive pulmonary embolism.
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Affiliation(s)
- Mohamed Rahouma
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA; (S.A.-T.); (S.K.); (S.M.)
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Shaikha Al-Thani
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA; (S.A.-T.); (S.K.); (S.M.)
| | - Haitham Salem
- Ain Shams University Hospital, Ain Shams University, Cairo 11517, Egypt;
| | - Alzahraa Mahmoud
- Faculty of Medicine, Beni Suef University, Beni Suef 2721562, Egypt;
| | - Sherif Khairallah
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA; (S.A.-T.); (S.K.); (S.M.)
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - David Shenouda
- New York Institute of Technology, New York, NY 10023, USA;
| | - Batool Sultan
- Rak Medical and Health Sciences University, Ras al Khaimah 11172, United Arab Emirates;
| | | | - Mohammad Alomari
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, FL 32224, USA; (M.A.); (M.A.); (I.A.M.); (J.C.H.)
| | - Mostafa Ali
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, FL 32224, USA; (M.A.); (M.A.); (I.A.M.); (J.C.H.)
| | - Ian A. Makey
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, FL 32224, USA; (M.A.); (M.A.); (I.A.M.); (J.C.H.)
| | - John C. Haney
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, FL 32224, USA; (M.A.); (M.A.); (I.A.M.); (J.C.H.)
| | - Stephanie Mick
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA; (S.A.-T.); (S.K.); (S.M.)
| | - Magdy M. El-Sayed Ahmed
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, FL 32224, USA; (M.A.); (M.A.); (I.A.M.); (J.C.H.)
- Surgery Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
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Surgical pulmonary embolectomy and catheter-based therapies for acute pulmonary embolism: A contemporary systematic review. J Thorac Cardiovasc Surg 2018; 156:2155-2167. [DOI: 10.1016/j.jtcvs.2018.05.085] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 12/26/2022]
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Surgical Embolectomy for Acute Pulmonary Embolism: Systematic Review and Comprehensive Meta-Analyses. Ann Thorac Surg 2017; 103:982-990. [DOI: 10.1016/j.athoracsur.2016.11.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/26/2016] [Accepted: 11/02/2016] [Indexed: 12/16/2022]
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Neely RC, Byrne JG, Gosev I, Cohn LH, Javed Q, Rawn JD, Goldhaber SZ, Piazza G, Aranki SF, Shekar PS, Leacche M. Surgical Embolectomy for Acute Massive and Submassive Pulmonary Embolism in a Series of 115 Patients. Ann Thorac Surg 2015; 100:1245-51; discussion 1251-2. [PMID: 26165484 DOI: 10.1016/j.athoracsur.2015.03.111] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/20/2015] [Accepted: 03/25/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pulmonary embolectomy is often indicated for central pulmonary embolism (PE) with hemodynamic instability, but remains controversial for hemodynamically stable patients with signs of right ventricular dysfunction. Because thrombolytic therapy is often contraindicated postoperatively, we reviewed risk factors and outcomes of pulmonary embolectomy for stable and unstable central PE, particularly in the early postoperative period. METHODS Between October 1999 and September 2013, 115 patients underwent pulmonary embolectomy for central, hemodynamically unstable PE (49 of 115, 43%) or hemodynamically stable PE (56 of 115, 49%). Ten operations for alternate indications (right atrial mass, endocarditis) were excluded for comparison analysis, leaving 105 patients. RESULTS Mean age was 59 ± 13 years; 46 of 105 patients (44%) had recent surgery (within 5 weeks): orthopedic (12 of 46, 25%), neurosurgery (11 of 46, 24%), or general surgery (10 of 46, 22%). Preoperative demographics did not differ between groups, except for the frequency of cardiopulmonary resuscitation among unstable patients (11 of 49, 22%) versus stable patients (0 of 56, 0%; p < 0.001). Operative mortality for the combined groups was 6.6% (7 of 105): unstable 10.2% (5 of 49) versus stable 3.6% (2 of 56; p = 0.247). Of 11 patients requiring preoperative cardiopulmonary resuscitation, 4 died. Six-month, 1-year, and 3-year survival rates were, respectively, 75%, 68.4%, and 65.8% for unstable PE, and 92.6%, 86.7%, and 80.4% for stable PE (p = 0.018). CONCLUSIONS This large series of pulmonary embolectomies demonstrates excellent early and late survival rates for patients with stable PE and unstable PE. These findings confirm pulmonary embolectomy as a beneficial therapeutic option for central PE, especially during the postoperative period when thrombolytic therapy is often contraindicated.
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Affiliation(s)
- Robert C Neely
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - John G Byrne
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Igor Gosev
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lawrence H Cohn
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Quratulain Javed
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - James D Rawn
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Samuel Z Goldhaber
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gregory Piazza
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sary F Aranki
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Prem S Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marzia Leacche
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
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Saeed G, Möller M, Neuzner J, Gradaus R, Stein W, Langebrake U, Dimpfl T, Matin M, Peivandi A. Emergent surgical pulmonary embolectomy in a pregnant woman: case report and literature review. Tex Heart Inst J 2014; 41:188-94. [PMID: 24808782 DOI: 10.14503/thij-12-2692] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acute pulmonary embolism is a leading cause of death during pregnancy and delivery in the United States. We describe the case of a 25-year-old woman who presented in cardiogenic shock in week 38 of her first pregnancy. After the emergent cesarean delivery of a healthy male neonate, the mother underwent immediate surgical pulmonary embolectomy. We confirmed the diagnosis of pulmonary embolism intraoperatively by means of transesophageal echocardiography and removed large clots from the patient's pulmonary arteries. Mother and child were doing well, 27 months later. In addition to presenting our patient's case, we discuss the other relevant reports and the options for treating massive pulmonary embolism during pregnancy.
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Affiliation(s)
- Giovanni Saeed
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Michael Möller
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Jörg Neuzner
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Rainer Gradaus
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Werner Stein
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Uwe Langebrake
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Thomas Dimpfl
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Meradjoddin Matin
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Ali Peivandi
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
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Zarrabi K, Zolghadrasli A, Ali Ostovan M, Azimifar A, Malekmakan L. Residual pulmonary hypertension after retrograde pulmonary embolectomy: long-term follow-up of 30 patients with massive and submassive pulmonary embolism. Interact Cardiovasc Thorac Surg 2013; 17:242-6. [PMID: 23677779 DOI: 10.1093/icvts/ivt210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Pulmonary hypertension is a major cause of morbidity and mortality in patients following acute pulmonary embolism. Although thrombolytic therapy decreases pulmonary arterial pressure, compared with anticoagulation alone, it has the propensity for haemorrhagic complications, distal embolization and incomplete recanalization, with the potential risk of late pulmonary hypertension. Surgical embolectomy-once performed solely on critically-ill patients-has now gained favour in a wider range of patients. In this paper we present the outcomes of patients who underwent surgical embolectomy complemented with retrograde technique and follow-up systolic pulmonary arterial pressure (SPAP). METHODS From January 2004 to December 2010, 30 consecutive patients with a mean age of 58±15 years underwent pulmonary embolectomy at our centre. The patients were followed for a mean period of 30.5±12 months. Their New York Heart Association (NYHA) classifications were assessed and their SPAPs were measured by echocardiography. RESULTS The overall mortality rate was 13.2% (4/30). Of the remaining patients, 19 patients (73.1%) were in NYHA classes I and II, 7 patients (26.9%) in class III and no patient in class IV. The patients' preoperative and postoperative mean SPAPs were 44.9±5.7 and 34.9±7.1 mmHg, respectively, which showed a significant reduction (P<0.001). The mean SPAP in the follow-up was 29.4±11.5 mmHg, which again showed significant reduction compared with early postoperation values (P<0.001). No significant correlations were found between the level of SPAP reduction in patients' follow-up with age (P=0.727) and total days of ICU admission (P=0.700), but weak correlations with sex (P=0.016) and total intubation time were noticed (P=0.035). CONCLUSIONS This is the first series reporting the long-term outcome of patients undergoing surgical embolectomy complemented by retrograde embolectomy technique, demonstrating the safety and favourable long-term outcome of this technique. It is also a new element in the growing body of evidence regarding the relevance of surgical embolectomy in patients with acute pulmonary embolism. We concluded that, following surgery, not only does the pulmonary arterial pressure drop immediately, but also the trend toward normalization continues long after operation.
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Affiliation(s)
- Khalil Zarrabi
- Department of Cardiac Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Marshall L, Mundy J, Garrahy P, Christopher S, Wood A, Griffin R, Shah P. Surgical pulmonary embolectomy: mid-term outcomes. ANZ J Surg 2012; 82:822-6. [DOI: 10.1111/j.1445-2197.2012.06190.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Lachlan Marshall
- Department of Cardiothoracic Surgery; Princess Alexandra Hospital; Brisbane; Queensland; Australia
| | - Julie Mundy
- Department of Cardiothoracic Surgery; Princess Alexandra Hospital; Brisbane; Queensland; Australia
| | - Paul Garrahy
- Department of Cardiology; Princess Alexandra Hospital; Brisbane; Queensland; Australia
| | - Sannah Christopher
- Department of Cardiothoracic Surgery; Princess Alexandra Hospital; Brisbane; Queensland; Australia
| | - Annabelle Wood
- Department of Cardiothoracic Surgery; Princess Alexandra Hospital; Brisbane; Queensland; Australia
| | - Rayleene Griffin
- Department of Cardiothoracic Surgery; Princess Alexandra Hospital; Brisbane; Queensland; Australia
| | - Pallav Shah
- Department of Cardiothoracic Surgery; Princess Alexandra Hospital; Brisbane; Queensland; Australia
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Garg P, Jain A, Kumar A, Chugh R. Surgical pulmonary embolectomy for submassive pulmonary embolism: a case report and review of the literature. Indian J Thorac Cardiovasc Surg 2012. [DOI: 10.1007/s12055-012-0139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Short-term results of retrograde pulmonary embolectomy in massive and submassive pulmonary embolism: a single-center study of 30 patients. Eur J Cardiothorac Surg 2011; 40:890-3. [DOI: 10.1016/j.ejcts.2011.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/31/2011] [Accepted: 06/07/2011] [Indexed: 11/17/2022] Open
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Successful usage of extracorporeal membrane oxygenation as a bridge therapy for acute pulmonary embolism between hospitals. Gen Thorac Cardiovasc Surg 2010; 58:283-6. [DOI: 10.1007/s11748-009-0540-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 09/03/2009] [Indexed: 11/26/2022]
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