In patients with acute pulmonary embolism (PE), surgical embolectomy demonstrated survival improvements, thus supporting the continued role of surgery in the multidisciplinary treatment of this high-risk condition.
A nationwide study was conducted in the United States in patients from the National Inpatient Sample who underwent systemic thrombolysis, catheter-directed therapy, or surgical embolectomy for acute PE between 2010 and 2014. Results of the analysis were published in The Annals of Thoracic Surgery.
Investigators sought to examine, on a nationwide scale, contemporary outcomes in patients treated for acute PE. The primary study outcome was all-cause in-hospital mortality. Secondary study outcomes included in-hospital myocardial infarction, cardiac arrest, complete heart block, major bleed, stroke, blood transfusion, cost, and length of hospital stay.
A total of 58,974 patients with acute PE were enrolled in the study. Of these individuals, 56.9% (33,553 of 58,974) were treated with systemic thromboembolism, 37.8% (22,336 of 58,974) received catheter-directed therapy, and 5.2% (3085 of 58,974) underwent surgical embolectomy. During the study period, the number of cases that required the use of these advanced treatments increased from 10,514 in 2010 to 13,975 in 2014. Systemic thromboembolism was the most commonly used treatment modality throughout all the years of the study, with a substantial increase in the volume of procedures after 2012.
The overall median age of the participants was 59 years and 49.4% were women. Patients who underwent surgical embolectomy compared with patients who received systemic thrombolysis or catheter-directed therapy, were significantly more likely to have atrial fibrillation (21.6% vs 12.1% vs 13.2%, respectively; P <.01), congestive heart failure (17.8% vs 13.5% vs 13.3%; P <.01), and paralysis or hemiplegia (4.6% vs 4.0%, vs 2.6%; P <.01).
Additionally, patients who underwent surgical embolectomy were also significantly more likely than those who were treated with systemic thrombolysis or catheter-directed therapy to have a saddle PE (21.6% vs 10.3% vs 10.4%; P <.01) and were more often classified as having a severe risk for mortality (55.9% vs 41.6% vs 25.8%; P <.01).
Patients who underwent surgical embolectomy, however, were significantly less likely than those who received systemic thrombolysis or catheter-directed therapy to be smokers (22.5% vs 26.3% vs 28.7%; P <.01), have chronic lung disease (13.8% vs 18.5% vs 21.2%; P <.01), or have a malignancy (6.8% vs 10.0% vs 12.7%; P <.01).
The investigators concluded that the results of this contemporary, real-world study “may add more evidence to clarify the role of [surgical embolectomy] within the multidisciplinary framework approach to acute PE” but added that the surgery should be used with caution in older patients with heart failure and non-saddle PE.
Percy ED, Shah R, Hirji S, et al. National outcomes of surgical embolectomy for acute pulmonary embolism [published online March 18, 2020]. Ann Thorac Surg. doi:10.1016/j.athoracsur.2020.02.024