Short-term results of retrograde pulmonary embolectomy in massive and submassive pulmonary embolism: a single-center study of 30 patients

Objective: Surgical pulmonary embolectomy is usually reserved for critically ill patients with pulmonary embolism. The conventional antegrade technique of embolectomy may miss peripheral clots, rendering the patient amenable to developing pulmonary hypertension. Here, we present our experience with a new retrograde pulmonary embolectomy supplementing the current antegrade technique. Methods: From January 2004 through December 2010, 30 consecutive patients underwent pulmonary embolectomy in our center. The study included 15 men and 15 women whose age ranged from 28 to 80 years, with mean age of 58 ± 15 years. All the patients except one were taken to the operating room with at least one imaging modality confirming the presence of a large thrombus in pulmonary-arterial vasculature. Results: The most common presenting symptoms of patients was dyspnea (n = 27, 90%). The major indications for surgery were severe hemodynamic or respiratory compromise (n = 11, 36%). After performing antegrade embolectomy, retrograde flushing of the pulmonary veins was done. The in-hospital mortality in our study was 6.6% (2/30). Mean intubation time for the patients was 52.7 ± 36.5 h, with a range of 12―120 h. Mean intensive care unit (ICU) admission for the patients was 7 days with a range of 2―60 days. Conclusions: As far as we know, this is the largest series of cases published so far regarding the immediate results of retrograde pulmonary embolectomy. This technique can successfulty dislodge the remaining clots in distal pulmonary vasculature not directly visualized. Surgical pulmonary embolectomy is a safe method and should not be used as a last resort for patients with pulmonary embolism.