Surgical Management of Pulmonary embolism : Single-center study

Ahmed Farouk Abd El Hafez; Nashwa Farouk Abd El Hafez; Heba Ahmed Hamed; Mohamed  Osman; Mohamed Farouk Abd El Hafez; Marina Kamal Fahmy

Ahmed Farouk Abd El Hafez Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
Nashwa Farouk Abd El Hafez Department of Anesthesia and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
Heba Ahmed Hamed Department of Pneumonology, Faculty of Medicine, Assiut University, Assiut, Egypt
Mohamed Osman Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
Mohamed Farouk Abd El Hafez Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
Marina Kamal Fahmy Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt

Keywords: Median sternotomy, Pulmonary embolism, Surgical pulmonary embolectomy, Submassive pulmonary embolism

Abstract

Background: Pulmonary embolism (PE) is considered one of the highest risk cardiovascular diseases. It is managed using medical (anticoagulants, thrombolytics) and/or surgical or catheter embolectomy. The indications and outcomes of the surgical embolectomy is a matter of controversy. So, the aim of the present work is to evaluate the outcomes of surgical embolectomy through median sternotomy with cardiopulmonary bypass surgery.

Methods: The current study is a prospective longitudinal cohort study for (17patients) who underwent surgical embolectomy at Assiut University Heart Hospital of Egypt during the period from September 2021 until September 2023.

A medical history, full examination, and thoracic echocardiography with pulmonary angiography were performed. All patients underwent surgical embolectomy through median sternotomy.

Results: The study included (17 patients), 5 males and 12 females, ranging from 38 to 60 years of age. Four patients presented with massive PE, and 13 suffered from submassive PE. The mean operative time was 172.65 + 24.76 min., and the mean clamp time was 42.59±13.70 min. The mean hospital stay for all patients was 8.65+1.22 days, and the mean Intensive Care Unit (ICU) stay was 2.3+0.6 days. Respiratory complications, stroke, and bleeding were present in 23.5%, 11.7%, and 17.6% of cases respectively. while congestive heart failure, fever, and melena were present in 11.76%, 11.76%and 5.88%. Four patients died postoperatively due to stroke (2 patients), bleeding (1 patient), and acute respiratory distress with multiorgan failure (1 patient). The mortality rate reported in our cases was about 24% (4/17 patients)

Conclusion: Surgical embolectomy through median sternotomy and cardiopulmonary bypass had favorable outcomes in cases of submassive PE, especially when other treatments are contraindicated or are not available.