OBJECTIVE

To study the immediate and long-term outcomes of open thromboembolectomy for massive and submassive pulmonary embolism (PE) in high-risk patients.

MATERIAL AND METHODS

The study included 30 high-risk patients (19 men and 11 women aged 21-81 years, median 55 years) with massive and submassive PE. All patients have undergone open thromboembolectomy for the period from January 2010 to February 2020. PE severity was determined considering CT angiography data. PESI index was calculated. Risk of early (within 30 days) PE-related mortality was determined taking into account echocardiography data and serum troponins. Postoperative outcomes were assessed in terms of in-hospital mortality and morbidity. In long-term period (12 and 24 months later), we analyzed long-term mortality, severity of pulmonary hypertension and chronic heart failure.

RESULTS

Patients with massive central pulmonary embolism prevailed (21 patients, 70%). The median PESI score was 122. In 22 (73%) patients, hemodynamic disorders were noted as a sign of high-risk PE. Seven (23%) patients had floating thrombi in the right cardiac chambers. PE with a tumor thrombus occurred in 5 (16.7%) patients. Isolated thromboembolectomy from pulmonary artery was performed in 19 patients; thromboembolectomy with concomitant cardiac surgery — 4 cases; thromboembolectomy with removal of intracardiac clots — 4 cases; thromboembolectomy, removal of floating thrombi from the right chambers and concomitant cardiac surgery — 3 patients. Overall mortality rate was 10% (3 patients), complications developed in 37% of patients (n=11). Long-term mortality caused by cancer, chronic heart failure and sepsis was 16.7% (n=5). Severe post-embolic pulmonary hypertension developed in 2 (9%) out of 23 examined patients.

CONCLUSION

Open thromboembolectomy for massive and submassive PE in high risk patients prevents early postoperative mortality, chronic post-embolic pulmonary hypertension and other complications in most cases.