Survival and Right Ventricular Function After Surgical Management of Acute Pulmonary Embolism

Authors

Joshua B Goldberg, New York Medical CollegeFollow
Daniel M. Spevack, New York Medical College
Syed AhsanFollow
Yogita Rochlani
Tanya Dutta, New York Medical CollegeFollow
Suguru Ohira, New York Medical CollegeFollow
Masashi Kai, New York Medical CollegeFollow
David Spielvogel, New York Medical CollegeFollow
Steven Lansman, New York Medical CollegeFollow
Ramin Malekan, New York Medical CollegeFollow

Award

Research Article Published in Journal with Highest Impact Factor for NYMC First Author (Journal Citation Reports 2020)

DOI

10.1016/j.jacc.2020.06.065

Journal Title

Journal of the American College of Cardiology

First Page

903

Last Page

911

Document Type

Article

Publication Date

8-25-2020

Department

Surgery

Second Department

Medicine

Keywords

Acute Disease, Embolectomy, Extracorporeal Membrane Oxygenation, Female, Heart Function Tests, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Patient Selection, Pulmonary Embolism, Recovery of Function, Risk Adjustment, Risk Factors, Severity of Illness Index, Ventricular Dysfunction, Right

Disciplines

Medicine and Health Sciences | Surgery

Abstract

BACKGROUND: Acute pulmonary embolism (PE) is associated with high morbidity and mortality because of right ventricular (RV) failure. There is evidence suggesting surgical therapy (surgical embolectomy or venoarterial extracorporeal membrane oxygenation [ECMO]) is safe and effective.

OBJECTIVES: The aim of this study was to assess the safety and efficacy of surgical management of acute PE.

METHODS: Surgical embolectomy and/or venoarterial ECMO were compared, between 2005 and 2019, for massive PE (MPE) versus high-risk submassive PE (SMPE). RV recovery was defined as improvements in central venous pressure, pulmonary artery systolic pressure, RV/left ventricular ratio, and RV fractional area change.

RESULTS: One hundred thirty-six patients with PE (92 with SMPE and 44 with MPE) were identified. Patients with MPE more often presented with syncope (59.1% [26 of 44] vs. 25.0% [23 of 92]; p = 0.0003), Glasgow Coma Scale score ≤4 (22.7% [10 of 44] vs. 0% [0 of 92]), and failed thrombolysis (18.2% [8 of 44] vs. 4.3% [3 of 92]; p = 0.008). Pre-operative cardiopulmonary resuscitation occurred in 43.2% of patients with MPE (19 of 44). Most patients with SMPE were treated with embolectomy (98.9% [91 of 92]), while ECMO was used more in those with MPE (ECMO in 40.9% [18 of 44], embolectomy in 59.1% [26 of 44]). RV function improved as measured by central venous pressure (from 23.4 ± 4.9 to 10.5 ± 3.1 mm Hg), pulmonary artery systolic pressure (from 60.6 ± 14.2 to 33.8 ± 10.7 mm Hg), RV/left ventricular ratio (from 1.19 ± 0.33 to 0.87 ± 0.23; p < 0.005), and fractional area change (from 26.8 to 41.0; p < 0.005). Mortality was 4.4% (6 of 136; SMPE, 1.1% [1 of 92]; MPE, 11.6% [5 of 44]). Subgroup analysis showed morbidity and mortality were highly associated with pre-operative cardiopulmonary resuscitation.

CONCLUSIONS: Surgical management of patients with MPE and high-risk SMPE is safe and highly effective at achieving RV recovery.

Recommended Citation

Goldberg, J., Spevack, D. M., Ahsan, S., Rochlani, Y., Dutta, T., Ohira, S., Kai, M., Spielvogel, D., Lansman, S., & Malekan, R. (2020). Survival and Right Ventricular Function After Surgical Management of Acute Pulmonary Embolism. Journal of the American College of Cardiology, 76 (8), 903-911. https://doi.org/10.1016/j.jacc.2020.06.065