Clinical Outcome of Acute Pulmonary Embolectomy Taken as to be the First Line Treatment for Massive and Submassive Pulmonary Embolism: Experience from One Single Center in China
Authors: QiMin Wang , Liangwan Chen , Daozhong Chen , Hanfan Qiu , Zhongyao Huang , Xiaofu Dai , Xueshan Huang , Feng Lin , Huabin Chen 
Published: August 2020

Abstract
Backgroud: Acute pulmonary embolism (PE) is one of the most critical cardiovascular disease. The treatment for PE depends on the severity of disease including anticoagulation, systemic thrombolysis, surgical embolectomy,and catheter embolectomy. The indication of surgical pulmonary embolectomy is still controvery. Although there have been more favourable reports of the of surgical embolectomy (SE) over past decades, SE has still been used as a resort or rescue treatment for acute massive PE with significant hemodynamically unstable or present with cardiogenic shock or patients whose thrombolysis failed，therefore the high mortality of pulmonary surgical embolectomy was still reported. SE has not yet been accepted broadly as initial therapy in the algorithm for massive and submassive PE.Objective : The purpose of this study is to evaluate the early and midterm outcome of surgical pulmonary embolectomy which was taken as the first line therapy for acute central major pulmonary embolism in one single center in ChinaMethods: A retrospective review of patients who underwent surgical pulmonary embolectomy for acute pulmonary embolectomy was conducted from July of 2005 to Sept of 2019 at a single heart center in China. Patients with chronic thrombus or thrombendrterectomy were excluded.The risk factors for morbidity and mortality of the surgical pulmonary embolectomy were reviewed, The institutional echocardiographic database was searched for follow-up studies to compare markers of right ventricular function.Results: A total of 41 patients were included for the study, 17 cases (41.5%) had submassive PE and 24 (58.5%) had massive pulmonary embolism required preoperative positive inotropic treatment. Mean cardiopulmonary bypass time was 103.2±48.9 minutes, and 10 patients (24.4.%) underwent procedures without aortic cross-clamping. Ventilatory support time was 80.6±21.3hours. ICU stay was 4.51±3.23 days. Hospital stay was 12.8±6.4days. There was operative mortality 3 (7.32%) for massive pulmonary embolism and no death case of submassive pulmonary embolism. For massive PE patients, if the first choice treatment was surgical embolectomy, the mortality was low,only 2.56%, even though there were 2 cases suffered from cardiac arrest preoperatively. However, if 2 cases who received systemic thromblysis firstly were included in the datus,the mortality rate of SE increased to 12.5%. All cases had echocardiography results available for follow-up at discharge,and 30 cases at three months, only 10 cases at one years after surgical embolectomy. There were no death event related with recurrent PE in the follow-up,but 3 patents died of cerebral incranal bleeding, gastric cancer and gastric cancer at 1 year,3 years and 8 years after surgical embolectomy respectively.Conclusions: In this small retrospective single center experience, SE presented with low mortality rate when it was rendered as the first line treatment in selected patients for massive and submassive acute pulmonary embolism. SE should play the the same role as ST in the treatment algorithm for acute PE. Echocardiographic showed right ventricular function was improved in the early and midterm follow- up term