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Journal of Cardiothoracic Surgery

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Open Access 01-12-2024 | Thrombectomy | Case Report

Simple and secure thrombectomy without circulatory arrest for acute pulmonary embolism

Authors: Hanae Sasaki, Ryosuke Kowatari, Norihiro Kondo, Masahito Minakawa

Published in: Journal of Cardiothoracic Surgery | Issue 1/2024

Abstract

Background

Surgical pulmonary artery thrombectomy is a well-established emergency treatment for massive pulmonary embolism (PE) in which fibrinolysis or thrombolysis are not effective. However, surgery for massive PE that requires peripheral pulmonary artery thrombus removal remains challenging. We established a simple and secure pulmonary artery thrombectomy method using cardiopulmonary bypass and cardiac arrest. In this procedure, the surgical assistant arm, typically used for coronary artery bypass grafting, is used to obtain a feasible working space during thrombectomy.

Case presentation

We present seven consecutive massive PE cases that were treated with the present surgical method and successfully weaned from cardiopulmonary bypass or extracorporeal membrane oxygenation postoperatively.

Conclusions

This procedure can be used to prevent right ventricular failure after surgery as surgeons can remove the peripheral thrombus with clear vision up to the second branch of the pulmonary artery.

Fukuda I, Taniguchi S. Embolectomy for acute pulmonary thromboembolism: from Trendelenburg’s procedure to the contemporary surgical approach. Surg Today. 2011;41:1–6. https://doi.org/10.1007/s00595-010-4416-8.CrossRefPubMed

Minakawa M, Fukuda I, Miyata H, Motomura N, Takamoto S, Taniguchi S, et al. Outcomes of pulmonary embolectomy for acute pulmonary embolism. Circ J. 2018;82:2184–90. https://doi.org/10.1253/circj.CJ-18-0371.CrossRefPubMed

Iaccarino A, Frati G, Schirone L, Saade W, Iovine E, D’Abramo M, et al. Surgical embolectomy for acute massive pulmonary embolism: state of the art. J Thorac Dis. 2018;10:5154–61. https://doi.org/10.21037/jtd.2018.07.87.CrossRefPubMedPubMedCentral

Fukuda W, Taniguchi S, Fukuda I, Chiyoya M, Aoki C, Kondo N, et al. Management of pulmonary thromboembolism based on severity and vulnerability to thrombolysis. Ann Vasc Dis. 2017;10:371–7. https://doi.org/10.3400/avd.oa.17-00105.CrossRefPubMedPubMedCentral

Goldberg JB, Spevack DM, Ahsan S, Rochlani Y, Dutta T, Ohira S, et al. Survival and right ventricular function after surgical management of acute pulmonary embolism. J Am Coll Cardiol. 2020;76(8):903–11. https://doi.org/10.1016/j.jacc.2020.06.065.CrossRefPubMed

Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS); 2019.

Azari A, Beheshti AT, Moravvej Z, Bigdelu L, Salehi M. Surgical embolectomy versus thrombolytic therapy in the management of acute massive pulmonary embolism: short and long-term prognosis. Heart Lung. 2015;44:335–9. https://doi.org/10.1016/j.hrtlng.2015.04.008.CrossRefPubMed

Keeling WB, Leshnower BG, Lasajanak Y, Binongo J, Guyton RA, Halkos ME, et al. Midterm benefits of surgical pulmonary embolectomy for acute pulmonary embolus on right ventricular function. J Thorac Cardiovasc Surg. 2016;152:872–8. https://doi.org/10.1016/j.jtcvs.2015.11.042.CrossRefPubMed

Jakob H, Vahl C, Lange R, Micek M, Tanzeem A, Hagl S. Modified surgical concept for fulminant pulmonary embolism. Eur J Cardiothorac Surg. 1995;9:557–60. https://doi.org/10.1016/s1010-7940(05)80005-3.CrossRefPubMed

10.

Klok FA, van der Hulle T, den Exter PL, Lankeit M, Huisman MV, Konstantinides S. The post-PE syndrome: a new concept for chronic complications of pulmonary embolism. Blood Rev. 2014;28:221–6. https://doi.org/10.1016/j.blre.2014.07.003.CrossRefPubMed

11.

Jamieson SW, Kapelanski DP, Sakakibara N, Manecke GR, Thistlethwaite PA, Kerr KM, et al. Pulmonary endarterectomy: experience and lessons learned in 1500 cases. Ann Thorac Surg. 2003;76:1457–62. https://doi.org/10.1016/s0003-4975(03)00828-2.CrossRefPubMed

12.

Dartevelle P, Fadel E, Mussot S, Chapelier A, Hervé P, de Perrot M, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2004;23:637–48. https://doi.org/10.1183/09031936.04.00079704.CrossRefPubMed

13.

Aymard T, Kadner A, Widmer A, Basciani R, Tevaearai H, Weber A, et al. Massive pulmonary embolism: surgical embolectomy versus thrombolytic therapy–should surgical indications be revisited? Eur J Cardiothorac Surg. 2013;43:90–4. https://doi.org/10.1093/ejcts/ezs123.CrossRefPubMed

Title: Simple and secure thrombectomy without circulatory arrest for acute pulmonary embolism
Authors: Hanae Sasaki
Ryosuke Kowatari
Norihiro Kondo
Masahito Minakawa
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Thrombectomy
ECMO
ECMO
Circulatory Arrest
Acute Pulmonary Embolism
Acute Pulmonary Embolism
Acute Pulmonary Embolism
Published in: Journal of Cardiothoracic Surgery / Issue 1/2024
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-024-02535-y

2024 ASCO Annual Meeting

Springer Medicine

Simple and secure thrombectomy without circulatory arrest for acute pulmonary embolism

Abstract

Background

Case presentation

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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