Review
Outcome of Pulmonary Embolectomy

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In view of the importance of pulmonary embolectomy as a possible treatment option in highly compromised patients with acute pulmonary embolism, a systematic review of immediate surgical outcomes was performed. Pooled data from 46 reported case series of patients operated from 1961 to 2006 showed an average mortality of 389 of 1,300 patients (30%). In patients operated on before 1985, the average mortality was 32%, compared with 20% in patients operated from 1985 to 2005. In patients who experienced cardiac arrest before pulmonary embolectomy, the operative mortality was 59% compared with 29% in patients who did not have preoperative cardiac arrest. In conclusion, despite generally high mortality in patients who undergo pulmonary embolectomy, it may have life-saving potential in some instances.

Section snippets

Methods and Results

We used established methods for systemic review.2, 3, 4 A search of the published research in all languages was performed incorporating electronic and manual components. The electronic search was performed using PubMed, which includes Medline, OLDMEDLINE, and Ovid, and the Cochrane Library database. PubMed was searched through June 2006. Search terms were “surgical embolectomy,” “Trendelenburg procedure,” “open embolectomy,” “free floating thrombi,” and “embolectomy matched pulmonary embolism.”

Discussion

Surgical mortality with pulmonary embolectomy has decreased in the past 2 decades but still remains high (20%). The reason for the reduced mortality since 1985 is not clear. Despite a generally high mortality in patients who undergo pulmonary embolectomy, it may have life-saving potential in some instances.

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