Outcome and quality of life after central pulmonary embolism: surgical embolectomy versus medical treatment

Aims: Therapy of massive pulmonary embolism (PE) is still a matter of debate. In our tertiary centre all modality of treatments are available. Aim of the present study was to assess outcome and mid-term quality of life (QoL) of patients with massive PE treated by surgical embolectomy (SE) or thrombolytic agents (TA).

Methods: 69 patients with central PE and severely compromised hemodynamics were identified. 19 patients (27.5%) were treated by SE and the remaining patients by TA. All in-hospital data was assessed and a follow-up, focusing on outcome and QoL was made.

Results: The surgical collective was younger (57.9±14.9 y vs.63.1±16.9; p<0.05) and more symptomatic at the time of diagnosis, with a Shock-Index of 1.3±0.6 vs.0.9±0.5 (p<0.05) and a pCO2 of 50.3±19.5mmHg vs.36.7±12.2mmHg (p<0.05) in patients treated with TA. Early mortality was similar in both collectives (SE:10.5% vs.TA:16.1%; p=ns) as well as follow-up survival after an average follow-up of 31.3±14.8 months (SE:68.4% vs. TA 66.1%; p=ns). 2 patients in the TA-group were hospitalized due to a massive PE during follow-up. 89.7% in the SE-group are under oral anticoagulation, compared to 81.8% in the TA-group (p=ns). No anticoagulation-related complications have been reported during follow-up. Average age- and gender-matched quality of life was similar in both groups (SE: 85.7 vs. TA 85.0; p=ns). Patients treated by TA reported a significant higher level of fear, than patients treated with SE.

Conclusions: SE is an excellent therapy of central PE in heamodynamically compromised patients, despite being more symptomatic early, mid-term outcome was similar in both groups. However, patients treated with TA are more scared.