Korean J Thorac Cardiovasc Surg 2019; 52(2): 78-84  https://doi.org/10.5090/kjtcs.2019.52.2.78
Acute Pulmonary Thromboembolism: 14 Years of Surgical Experience
Jiye Park , M.D., Sang-Hyun Lim , M.D., Ph.D., You Sun Hong , M.D., Soojin Park , M.D., Cheol Joo Lee , M.D., Ph.D., Seung Ook Lee , M.D.
Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
Corresponding author: Sang-Hyun Lim, Department of Thoracic and Cardiovascular Surgery, Ajou University Hospital, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea,
(Tel) 82-62-464-4615 (Fax) 82-31-219-5215 (E-mail) dbricasa@aumc.ac.kr
Received: July 16, 2018; Revised: November 9, 2018; Accepted: November 12, 2018.; Published online: April 5, 2019.
© The Korean Journal of Thoracic and Cardiovascular Surgery. All rights reserved.

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Abstract
Background: Pulmonary thromboembolism (PTE) is a life-threatening disease with high mortality. This study aimed to assess the outcomes of surgical embolectomy and to clarify the sustained long-term effects of surgery by comparing preoperative, postoperative, and long-term follow-up echocardiography outcomes. Of 22 survivors, 21 were followed up for a mean (median) period of 6.8±5.4 years (4.2 years).
Methods: We retrospectively reviewed 27 surgical embolectomy cases for massive or submassive acute PTE from 2003 to 2016. Immediate and long-term follow-up outcomes of surgical embolectomy were assessed on the basis of 30-day mortality, long-term mortality, postoperative complications, right ventricular systolic pressure, and tricuspid regurgitation grade.
Results: The 30-day and long-term mortality rates were 14.8% (4 of 27) and 4.3% (1 of 23), respectively. Three patients had major postoperative complications, including hypoxic brain damage, acute kidney injury, and endobronchial b leeding, respectively (3.7% each). Right ventricular systolic pressure (median [range], mm Hg) decreased from 62.0 (45.5–78.5) to 31.0 (25.7–37.0, p<0.001). The tricuspid valve regurgitation grade (median [range]) decreased from 1.5 (0.63–2.00) to 0.50 (0.50–1.00, p<0.05). The improvement lasted until the last echocardiographic follow-up.
Conclusion: Surgical embolectomy revealed favorable mortality and morbidity rates in patients with acute massive or submassive PTE, with sustained long-term improvements in cardiac function.
Keywords: Pulmonary embolism, Outcomes, Surgery, complications, Cardiopulmonary bypass, Echocardiography


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