Pulmonary Surgery Linked to Better Outcomes Than Drug Therapy

A surgical procedure used to treat acute pulmonary embolisms (PE) that was phased out in the 1950’s was found to actually prevent more deaths in severely ill patients than solely administering drug therapy, a study published in the Texas Heart Institute Journal suggested.

A ten-year report conducted by North Shore-LIJ Health System analyzed pulmonary embolectomies—which 12 previous studies conducted from 1961 to 1984 determined the method had a 32 percent mortality rate. Due to this evidence, the procedure has been deemed archaic and dangerous, a news release mentioned.

However, a combination of the implementation of safer techniques, urgency, and better outcomes, have encouraged surgeons to conduct operations, the statement also pointed out.

Led by Alan Hartman, MD, chair of cardiovascular and thoracic surgery at North Shore-LIJ, the team reviewed medical records, identifying 96 patients who were diagnosed with severe, globally hypokinetic right ventricular (RV) dysfunction from January 2003 through December 2011. The patients experienced either a large clot burden in the main pulmonary arteries or a saddle embolism—a clot that blocks the bifurcation of the main pulmonary artery—and underwent a pulmonary arteriotomy and clot extraction.

Looking at factors such as post-operative length of stay, readmission status, and post-operative complications, the authors reported, “The overall 30-day mortality rate was 4.2 percent. Most patients (68 [73.9 percent]) were discharged home or to rehabilitation facilities (23 [25 percent]). Hemodynamically stable patients with severe, globally hypokinetic right ventricular dysfunction had a 30-day mortality rate of 1.4 percent, with a postoperative mean length of stay of 9.1 days. Comparable findings for hemodynamically unstable patients were 12.5 percent and 13.4 days, respectively.”

However, there are factors that influence the surgery’s success. Coming into a hospital room, a patient may be ineligible for thrombolytic therapy and may benefit from an acute pulmonary embolectomy. Hartman—who highlighted cases where the patient who would’ve suffered from adverse reactions if not for surgery—warned the surgery’s effectiveness and safety also hinges on the surgeon’s experience, ability, and accurate patient selection.

“Our experience suggests that the appropriateness of surgery for acute PE revolves around 3 important principles: the significance of RV dysfunction on transthoracic echocardiography (TTE) or computed-tomographic-angiography (CTA), the presence of contraindications for thrombolytic therapy, and the safety of the surgical procedure being offered,” the investigators concluded. “Overall, our findings suggest that pulmonary embolectomy is a viable approach to consider as part of the treatment repertoire.”