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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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LeVarge BL, Wright CD, Rodriguez-Lopez JM. Surgical Management of Acute and Chronic Pulmonary Embolism. Clin Chest Med 2019; 39:659-667. [PMID: 30122189 DOI: 10.1016/j.ccm.2018.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Surgical pulmonary embolectomy and pulmonary thromboendarterectomy are well-established treatment strategies for patients with acute and chronic pulmonary embolism, respectively. For both procedures, techniques and outcomes have evolved considerably over the past decades. Patients with massive and submassive acute pulmonary embolism are at risk for rapid decline owing to right ventricular failure and shock. When thrombus is proximal, embolectomy can rapidly restore cardiac function. Chronic thromboembolic pulmonary hypertension is a more complex disease that requires skilled, careful dissection of the arterial wall, including vascular intima. When successful, surgery leads to clinical cure of the associated pulmonary hypertension, with excellent long-term outcomes.
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Affiliation(s)
- Barbara L LeVarge
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, 130 Mason Farm Road CB 7020, Chapel Hill, NC 27599, USA.
| | - Cameron D Wright
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Josanna M Rodriguez-Lopez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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