Surgical Treatment of Pulmonary Thromboembolism: Our Experience

Alexander Medvedev ¹, Vladimir Pichugin ¹, Svetlana Nemirova ¹, Anton Maximov ², Olga Shirokova ², Vladimir Chiginev ², Oleg Demarin ², Maria Kalinina ¹

¹ Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia; ² Specialized Clinical Cardiosurgical Hospital, Nizhny Novgorod, Russia;

Date, time and location: 2018.05.26 17:00, Press Hall, 2F

Abstract

Objective.The aim of the study was to optimize indications and evaluate results of surgical treatment of patients with PE and a high risk of early death.

Material and methods.165 patients with pulmonary artery subtotal obstruction were operated, including 55 elderly patients and three patients with pregnancy. There were 89 men, 76 women (mean age 49.3 ± 24, 1). High risk of early death was diagnosed in all operated patients. Mean pulmonary artery pressure was 59.2 ± 7.4 mm Hg. All operations were performed under normothermic cardiopulmonary bypass, in 110 cases - without aorta cross clamping. Associated surgical procedures were performed in 16 cases.

Results. All patients were divided into 3 groups. In first group patients (66) had unstable hemodynamic parameters, embolism "in motion", life threatening paradoxical embolism, intracardiac thrombi, clinical death, as well as ineffectiveness or impossibility of TLT. An emergency thromboembolectomy was performed; retrograde pulmonary perfusion was added in 11 cases. There were not lethal outcomes in this group. In second group patients (63) had unstable compensation of hemodynamic, a short-term positive effect of TLT with following increased pulmonary hypertension and symptoms of RV dysfunction. 2 patients died in this group after surgery. Third group consisted of patients (36) with recurrent pulmonary embolism with shock and progressive RV dysfunction, increased pulmonary hypertension. 2 patients died in this group after surgery. Overall hospital mortality was 2.4%. Pulmonary artery pressure decreased to an average of 23.8 ± 9.0 mm Hg.

Conclusion. Indications for surgical pulmonary embolectomy included thromboembolism of the trunk, main and lobar arteries with more than 50% occlusion of the pulmonary vascular bed, progressive pulmonary hypertension, progressive right ventricular dysfunction and shock if TLT was ineffective or impossible. Surgical restoring of pulmonary blood flow is an effective operation and allows complete regression of cardiopulmonary pathology.