Abstract
Pulmonary embolism (PE) is a common medical condition associated with significant
morbidity and mortality. It is the third most common cause of death in the United
States. Historically, surgery for PE was associated with a high mortality rate, and
this led to a significant decrease in the volume of operations being performed. However,
significant improvements in patient selection and outcomes for surgical pulmonary
embolectomy (SPE) at the end of the 20th century led to a renewed interest in the
procedure. SPE was historically reserved for patients presenting with acute PE and
hemodynamic collapse or cardiac arrest. Contemporary data has provided sufficient
evidence to support earlier intervention for patients with acute PE who demonstrate
clinical, laboratory, and echocardiographic signs of right ventricular dysfunction.
Institutions with cardiac surgery capabilities are implementing SPE earlier for the
management of both massive and submassive PEs with excellent short-term and long-term
outcomes. Recently, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has
been employed successfully to treat patients with massive PE. Excellent short-term
outcomes have been reported for patients suffering from PE after treatment with VA-ECMO.
Further research, specifically with randomized controlled trials, is needed to determine
the appropriate timing and patient selection for the use of VA-ECMO in patients with
PE. These data would lead to updated guidelines and algorithms incorporating VA-ECMO
and SPE for patients with PE.
Keywords
surgical embolectomy - massive PE - submassive PE - VA-ECMO - catheter-directed -
thrombolysis
