Comparison of Surgical Embolectomy and Veno-Arterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism

Authors

Joshua B. Goldberg, Section of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York. Electronic address: joshua.goldberg@wmchealth.org.Follow
Daniel M. Spevack, Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York.
Syed Ahsan, Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York.Follow
Yogita Rochlani, Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York.
Suguru Ohira, Section of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.Follow
Philip Spencer, Section of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.Follow
Masashi Kai, Section of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.Follow
Ramin Malekan, Section of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.Follow
David Spielvogel, Section of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.
Steven Lansman, Section of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.Follow

Author Type(s)

Faculty

DOI

10.1053/j.semtcvs.2021.06.011

Journal Title

Seminars in Thoracic and Cardiovascular Surgery

First Page

934

Last Page

942

Document Type

Article

Publication Date

1-1-2022

Department

Surgery

Second Department

Medicine

Keywords

Extracorporeal membrane oxygenation, Pulmonary embolism, Right ventricular failure, Surgical embolectomy, Survival

Disciplines

Medicine and Health Sciences

Abstract

Massive pulmonary embolism (MPE) is associated with a 20-50% mortality rate with guideline directed therapy. MPE treatment with surgical embolectomy (SE) or venoarterial extracorporeal membrane oxygenation (VA-ECMO) have shown promising results. In the context of a surgical management strategy for MPE, a comparison of outcomes associated with VA-ECMO or SE was performed. A retrospective review of a single institution cardiac surgery database was performed, identifying MPE treated with SE or VA-ECMO between 2005-2020. Primary outcome was in-hospital survival. 59 MPE [27 (46.8%) VA-ECMO vs 32 (54.2%) SE] were identified. All presented with elevated cardiac biomarkers, tachycardia (mean heart rate 113 ± 20 beats/minute), hypotension (mean systolic blood pressure 85 ± 22 mm Hg) and vasopressors requirement, without significant differences between cohorts. Preoperative CPR was performed in 37.3% (22/59), without a significant difference between cohorts. More VA-ECMO presented with questionable neurologic status (GCS ≤ 4) [9/27 (33.3%) vs 2/32 (6.2%), P = 0.008] and more VA-ECMO failed thrombolysis [8/27 (29.6) vs 2/32 (6.3), P = 0.014]. All presented with severe RV dysfunction, by discharge all had normalization of echocardiographic RV function. Overall mortality was 10.2%, with a trend toward higher mortality among VA-ECMO [14.9% (4/27) vs 6.3% (2/32) P = 0.14]. CPR was independently associated with death (OR 10.8, P = 0.02) whereas treatment modality was not (OR 0.24). In an extremely unstable MPE population VA-ECMO and SE were safely performed with low mortality while achieving RV recovery. Adverse outcomes were more closely associated with preoperative CPR than with treatment modality.

Recommended Citation

Goldberg, J. B., Spevack, D. M., Ahsan, S., Rochlani, Y., Ohira, S., Spencer, P., Kai, M., Malekan, R., Spielvogel, D., & Lansman, S. (2022). Comparison of Surgical Embolectomy and Veno-Arterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism. Seminars in Thoracic and Cardiovascular Surgery, 34 (3), 934-942. https://doi.org/10.1053/j.semtcvs.2021.06.011