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