Clinical Study Of Early Surgical Pulmonary Embolectomy For Patients With Acute Pulmonary Embolism

Objective: Acute pulmonary embolism is regarded as one of the most life-threatening cardiovascular diseases.Most of the acute pulmonary embolism high-risk mortality associated with hemodynamically unstable patients,which often needs reperfusion therapy.With the development of technology,the mortality rate of surgical pulmonary embolectomy is significantly improved,but there is still controversy regarding surgical pulmonary embolectomy mortality and trauma,due to the wide range of clinical symptoms.Therefore,this study mainly discussed the indications for surgery,surgical methods,perioperative management in the treatment of patients with acute pulmonary embolism,and analyzed the feasibility and efficacy of surgery.Methods: The clinical data of 51 patients with acute pulmonary embolism who underwent surgical pulmonary embolectomy in our hospital from October 2016 to July2020 were retrospectively analyzed.Records including:（1）General information: the age,gender,body mass index（BMI）,history of coronary heart disease,history of coronary heart disease（CHD）,hypertension,diabetes,etc.（2）Clinical manifestations:main clinical symptoms on admission,respiratory rate,oxygenation index,systolic blood pressure,etc.（3）Biochemical test and imaging examination: routine blood test,liver renal function test,plasma D-dimer,fibrinogen,troponin,ultrasonic cardiogram,vascular ultrasound,echocardiography,computed tomography pulmonary angiography,etc.;（4）Perioperative data: cardiopulmonary bypass（CPB）time,operation time,postoperative bleeding,secondary thoracotomy hemostasis,surgical wound bad healing,new dialysis,secondary endotracheal intubation and other complications;（5）The corresponding follow-up data of patients.Statistical analysis was performed using the SPSS Statistics 22.0.Normal distribution data were presented as mean ± standard deviation（`x±s）,the preoperative and postoperative data were compared by paired sample T test.Non-normal distribution data were presented as median with an interquartile range M（Q1,Q3）.For repeated measures data between multiple groups,continuous variables were compared by using two-factor analysis of variance,and classification variables using K related samples test（Cochran’s Q）test.P value <0.05 was considered statistically significant.Results: A total of 51 patients with acute pulmonary embolism were included in this study,including 22 males and 29 females,and the average age of the whole group was（61.7±13.1）years.Diabetes mellitus in 2 cases,hypertension in 7 cases,coronary heart disease in 4 cases,smoking and drinking history in 12 cases.The most common presenting symptoms were dyspnea（n = 49,96.1%）,chest pain（n = 22,43.1%）,syncope（n = 13,25.5%）,cardiac arrest（n = 3,5.9%）.One patient died of massive hemorrhage during perioperative period,with a mortality rate of about 2.0%,1 patient developed hypoxic-ischemic brain damage,8 patients had prolonged endotracheal intubation time（>24 h）,including 2 patients underwent secondary intubation,and no thoracotomy hemostasis,poor wound healing,sepsis,new dialysis and massive bleeding complications occurred.The hemodynamic indexes of 50 survivals were significantly improved.In 34 patients with complete trans-esophageal echocardiography data,pulmonary artery systolic blood pressure and tricuspid regurgitation was significantly improved compared with preoperative（P<0.01）.After discharge,a total of 50 patients were followed up for 7~41 months.The symptoms of all patients were significantly improved compared with pre-operation,and the most recent NYHA cardiac function classification: 8 cases in grade I,36 cases in Grade II,5 cases in grade III and 1 case in grade IV.There were no adverse events of death,recurrent pulmonary embolism,or massive bleeding,etc.Conclusion:1.Early pulmonic embolectomy is a safe and effective method for patients with acute massive pulmonary embolism.2.Surgical pulmonary embolectomy combined with inferior vena cava filter was secure,with the low incidence of recurrent pulmonary embolism and bleeding complications.3.Not only the success rate of surgical pulmonary embolectomy for patients with acute pulmonary embolism has a very high rate,there still were low rate of complications,such as hypoxemia and reperfusion injury.