• Ann. Thorac. Surg. · Aug 2020

    National Outcomes of Surgical Embolectomy for Acute Pulmonary Embolism.

    • Edward D Percy, Rohan Shah, Sameer Hirji, Richard J Tartarini, Farhang Yazdchi, Morgan Harloff, Tsuyoshi Kaneko, and Marc P Pelletier.
    • Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
    • Ann. Thorac. Surg. 2020 Aug 1; 110 (2): 441-447.

    BackgroundGuidelines outlining the role of surgical embolectomy for acute pulmonary embolism remain consensus based; however, recent outcomes have improved compared with traditional experiences. This study examined contemporary outcomes of patients treated for acute pulmonary embolism on a nationwide scale.MethodsPatients undergoing systemic thrombolysis, catheter-directed therapy, and surgical embolectomy for acute pulmonary embolism from 2010 to 2014 in the National Inpatient Sample were included.ResultsThe study included 58,974 patients with acute pulmonary embolism; of these, 33,553 were treated with systemic thrombolysis, 22,336 with catheter-directed therapy, and 3085 underwent surgical embolectomy. Thrombolysis was the most common, with a substantial increase after 2012, while surgical volumes remained stable. Patients in the surgical group, compared with systemic thrombolysis and catheter-directed therapy, had more saddle emboli (22% vs 10% vs 10%) and were more frequently at severe risk of death (56% vs 42% vs 26%; both P < .01). Surgical embolectomy patients had higher in-hospital mortality (20% vs 16% vs 7%), stroke (7% vs 6% vs 3%), and blood transfusion (32% vs 16% vs 10%; all P < .01). Rates of major bleeding and intracranial hemorrhage were highest in the systemic thrombolysis group. Among surgical patients, age older than 60 years, atrial fibrillation and nonsaddle embolus were associated with increased odds of mortality.ConclusionsIn this contemporary, real-world study, mortality occurred in 19.8% of patients undergoing surgical embolectomy for acute pulmonary embolism. This represents a significant improvement compared with traditional outcomes and supports the role of surgery in the multidisciplinary treatment of this high-risk condition.Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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