Surgical embolectomy as a promising treatment of acute pulmonary embolism

Highlights. The article presents current literature data on the results of surgical treatment of acute pulmonary embolism.

Abstract. The review article throws light on up to date approaches to the treatment of acute pulmonary embolism. The great variety of treatment methods and controversial results do not allow us to conclusively decide on which method to choose. Traditionally, pharmacological therapies have been favored over invasive methods because of the lower mortality rate. However, based on new studies, it can be established that interventional embolectomy is an effective option, showing good immediate and long-term results. Undoubtedly, additional studies are needed in order that surgical embolectomy developed from a rescue therapy of acute pulmonary embolism into a first-line or priority treatment.

1. Barco S., Valerio L., Ageno W., Cohen A.T., Goldhaber S.Z., Hunt B.J., et al. Age-sex specific pulmonary embolismrelated mortality in the USA and Canada, 2000-18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database. Lancet Respir Med. 2021; 9(1):33-42. doi: 10.1016/S2213-2600(20)30417-3

2. Konstantinides S.V., Meyer G., Becattini C., Bueno H., Geersing G.J., Harjola V.P., et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. doi: 10.1093/eurheartj/ehz405

3. Mouedder F., Laachach H., Elyandouzi A., Fliti A., Toutai C., Ismaili N., Elouafi N. Une embolie pulmonaire simulant un syndrome coronarien aigu [Pulmonary embolism mimicking acute coronary syndrome]. Pan Afr Med J. 2019;33:75. French. doi: 10.11604/pamj.2019.33.75.18355

4. Duffett L., Castellucci L.A., Forgie M.A. Pulmonary embolism: update on management and controversies. BMJ. 2020;370:m2177. doi: 10.1136/bmj.m2177

5. Jawad M., Apsey C. To Thrombolyse or Not to Thrombolyse: Two Years Experience of Thrombolysis of SubMassive Pulmonary Embolism in a District General Hospital. Cureus. 2020;12(11):e11359. doi: 10.7759/cureus.11359

6. Panahi L., Udeani G., Horseman M., Weston J., Samuel N., Joseph M., Mora A., Bazan D. Review of Medical Therapies for the Management of Pulmonary Embolism. Medicina (Kaunas). 2021;57(2):110. doi: 10.3390/medicina57020110

7. Rehman N.U., Dar M.I., Bansal M., Kasliwal R.R.. Clinical outcomes of submassive pulmonary embolism thrombolysis-an Indian experience. Egypt Heart J. 2020 ;72(1):87. doi: 10.1186/s43044-020-00123-8

8. Wang K.L., Kao Y.T., Chang W.T., Chang H.Y., Huang W.C., Hsu P..C, et al. Management of Venous Thromboembolisms: Part II. The Consensus for Pulmonary Embolism and Updates. Acta Cardiol Sin. 2020;36(6):562-582. doi: 10.6515/ACS.202011_36(6).20200917A

9. Ageno W., Haas .S, Weitz J.I., Goldhaber S.Z., Turpie A.G., Goto S., et al; GARFIELD-VTE investigators. Characteristics and Management of Patients with Venous Thromboembolism: The GARFIELD-VTE Registry. Thromb Haemost. 2019;119(2):319-327. doi: 10.1055/s-0038-1676611

10. Anderson D.R., Morgano G.P., Bennett C., Dentali .F, Francis C.W., Garcia D.A., et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019;3(23):3898- 3944. doi: 10.1182/bloodadvances.2019000975

11. Rivera-Lebron B.N., Rali P.M., Tapson V.F.. The PERT Concept: A Step-by-Step Approach to Managing Pulmonary Embolism. Chest. 2021;159(1):347-355. doi: 10.1016/j.chest.2020.07.065

12. Marti C., John G., Konstantinides S., Combescure C., Sanchez O., Lankeit M., Meyer G., Perrier A. Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis. Eur Heart J. 2015;36(10):605-614. doi: 10.1093/eurheartj/ehu218

13. Martinez Licha C.R., McCurdy C.M., Maldonado S.M., Lee L.S. Current Management of Acute Pulmonary Embolism. Ann Thorac Cardiovasc Surg. 2020;26(2):65-71. doi: 10.5761/atcs.ra.19-00158

14. Rivera-Lebron B., McDaniel M., Ahrar K., Alrifai A., Dudzinski D.M., Fanola C., et al; PERT Consortium. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin Appl Thromb Hemost. 2019;25:1076029619853037. doi: 10.1177/1076029619853037

15. Jaber W.A., Fong P.P., Weisz G., Lattouf O., Jenkins J., Rosenfield K., Rab T., Ramee S. Acute Pulmonary Embolism: With an Emphasis on an Interventional Approach. J Am Coll Cardiol. 2016 Mar 1;67(8):991-1002. doi: 10.1016/j.jacc.2015.12.024

16. Howard L. Acute pulmonary embolism. Clin Med (Lond). 2019;19(3):243-247. doi: 10.7861/clinmedicine.19-3-247

17. Keeling W.B., Sundt T., Leacche M., Okita Y., Binongo J., Lasajanak Y., Aklog L., Lattouf O.M.; SPEAR Working Group. Outcomes After Surgical Pulmonary Embolectomy for Acute Pulmonary Embolus: A Multi-Institutional Study. Ann Thorac Surg. 2016;102(5):1498-1502. doi: 10.1016/j.athoracsur.2016.05.004

18. Maturana M.A., Seitz M.P., Pour-Ghaz I., Ibebuogu U.N., Khouzam R.N. Invasive Strategies for the Treatment of Pulmonary Embolism. Where Are We in 2020? Curr Probl Cardiol. 2021;46(3):100650. doi: 10.1016/j.cpcardiol.2020.100650

19. Faluk M., Hasan S.M., Chacko J.J., Abdelmaseih R., Patel J. Evolution of Acute Pulmonary Embolism Management: Review Article. Curr Probl Cardiol. 2021;46(3):100551. doi: 10.1016/j.cpcardiol.2020.100551

20. Matveeva N.V., Narcissova G.P., Karpenko A.A., Chernjavskij M.A. Ocenka remodelirovanija polostej serdca u pacientov s ostroj trombojemboliej legochnoj arterii metodom transtorakal'noj jehokardiografii. Patologija krovoobrashhenija i kardiohirurgija. 2013;17(1):11-14. (In Russ.). doi:10.21688/1681-3472-2013-1-11-14

21. Jimenez D., Martin-Saborido C., Muriel A., Zamora J., Morillo R., Barrios D., et al. Efficacy and safety outcomes of recanalisation procedures in patients with acute symptomatic pulmonary embolism: systematic review and network meta-analysis. Thorax. 2018;73(5):464-471. doi: 10.1136/thoraxjnl-2017-210040

22. Delmas C., Aissaoui N., Meneveau N., Bouvaist H., Rousseau H., Puymirat E., et al. Reperfusion therapies in pulmonary embolism-state of the art and expert opinion: A position paper from the "Unité de Soins Intensifs de Cardiologie" group of the French Society of Cardiology. Arch Cardiovasc Dis. 2020;113(11):749-759. doi: 10.1016/j.acvd.2020.06.002

23. Gallo A., Valerio L., Barco S. The 2019 European guidelines on pulmonary embolism illustrated with the aid of an exemplary case report. Eur Heart J Case Rep. 2021;5(2):ytaa542. doi: 10.1093/ehjcr/ytaa542

24. Choi J.H., O'Malley T.J., Maynes E.J., Weber M.P., D'Antonio N.D., Mellado M, et al. Surgical Pulmonary Embolectomy Outcomes for Acute Pulmonary Embolism. Ann Thorac Surg. 2020;110(3):1072-1080. doi: 10.1016/j.athoracsur.2020.01.075

25. Azari A., Beheshti A.T., Moravvej Z., Bigdelu L., Salehi M. Surgical embolectomy versus thrombolytic therapy in the management of acute massive pulmonary embolism: Short and long-term prognosis. Heart Lung. 2015;44(4):335-9. doi: 10.1016/j.hrtlng.2015.04.008

26. Cho Y.H., Kim W.S. Surgical embolectomy as a first line treatment for acute massive pulmonary embolism. Int J Cardiol. 2016;222:785. doi: 10.1016/j.ijcard.2016.08.111.

27. Neely R.C., Byrne J.G., Gosev I., Cohn L.H., Javed Q., Rawn J.D., et al. Surgical Embolectomy for Acute Massive and Submassive Pulmonary Embolism in a Series of 115 Patients. Ann Thorac Surg. 2015;100(4):1245-51

28. Dudzinski D.M., Giri J., Rosenfield K. Interventional Treatment of Pulmonary Embolism. Circ Cardiovasc Interv. 2017;10(2):e004345. doi: 10.1161/CIRCINTERVENTIONS.116.004345

29. Myers P.O., Bounameaux H., Panos A., Lerch R., Kalangos A. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest. 2010;137(1):164-70. doi: 10.1378/chest.09-0961

30. Nosher J.L., Patel A., Jagpal S., Gribbin C., Gendel V. Endovascular treatment of pulmonary embolism: Selective review of available techniques. World J Radiol. 2017;9(12):426- 437. doi: 10.4329/wjr.v9.i12.426

31. Percy E.D., Shah R., Hirji S., Tartarini R.J., Yazdchi F., Harloff M., Kaneko T., Pelletier M.P. National Outcomes of Surgical Embolectomy for Acute Pulmonary Embolism. Ann Thorac Surg. 2020;110(2):441-447. doi: 10.1016/j.athoracsur.2020.02.024

32. Tarasov R.S., Kazantsev A.N., Kokov A.N., Bezdenezhny A.V., Kondrikova N.V., Sergeeva T.Y., Sizova I.N., Barbarash L.S. Three-year results of medical and surgical reperfusional treatment of patients transposed by thromboembolia of pulmonary artery: outcome, clinical status, state of pulmonary perfusion. Complex Issues of Cardiovascular Diseases. 2017;(3):71-83. (In Russ.). doi:10.17802/2306-1278-2017-6-3-71-83

33. Fukuda I., Daitoku K. Surgical Embolectomy for Acute Pulmonary Thromboembolism. Ann Vasc Dis. 2017;10(2):107- 114. doi: 10.3400/avd.ra.17-00038

34. Kalra R., Bajaj N.S., Arora P., Arora G., Crosland W.A., McGiffin D.C., Ahmed MI.. Surgical Embolectomy for Acute Pulmonary Embolism: Systematic Review and Comprehensive Meta-Analyses. Ann Thorac Surg. 2017;103(3):982-990. doi: 10.1016/j.athoracsur.2016.11.016

35. Abdulyanov I.V., Vagizov I.I., Omelyanenko A.S. Contemporary approach to treatment of pulmonary artery thromboembolia. Practical Medicine.2015; 2(88):35-40. (In Russ)

36. Edelman J.J., Okiwelu N., Anvardeen K., Joshi P., Murphy B., Sanders L.H., Newman M.A., Passage J. Surgical Pulmonary Embolectomy: Experience in a Series of 37 Consecutive Cases. Heart Lung Circ. 2016;25(12):1240-1244. doi: 10.1016/j.hlc.2016.03.010

37. Park J., Lim S.H., Hong Y.S., Park S., Lee C.J., Lee S.O. Acute Pulmonary Thromboembolism: 14 Years of Surgical Experience. Korean J Thorac Cardiovasc Surg. 2019;52(2):78- 84. doi: 10.5090/kjtcs.2019.52.2.78

38. Tak T., Karturi S., Sharma U., Eckstein L., Poterucha J.T., Sandoval Y. Acute Pulmonary Embolism: Contemporary Approach to Diagnosis, Risk-Stratification, and Management. Int J Angiol. 2019;28(2):100-111. doi: 10.1055/s-0039-1692636

39. Tak T., Karturi S., Sharma U., Eckstein L., Poterucha J.T., Sandoval Y. Acute Pulmonary Embolism: Contemporary Approach to Diagnosis, Risk-Stratification, and Management. Int J Angiol. 2019;28(2):100-111. doi: 10.1055/s-0039-1692636

40. QiMin W., LiangWan C., DaoZhong C., HanFan Q., ZhongYao H., XiaoFu D., XueShan H., Feng L., HuaBin C. Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism: a single-centre study in China. J Cardiothorac Surg. 2020;15(1):321. doi: 10.1186/s13019-020-01364-z

41. Kon Z.N., Pasrija C., Bittle G.J., Vemulapalli S., Grau-Sepulveda M.V., Matsouaka R., et al. The Incidence and Outcomes of Surgical Pulmonary Embolectomy in North America. Ann Thorac Surg. 2019;107(5):1401-1408. doi: 10.1016/j.athoracsur.2018.10.035.

42. Lattouf O.M., Laan D., Zapata D., Assaf E.J., Fallon J. Lessons learned on a new procedure: Nonsternotomy minimally invasive pulmonary embolectomy. J Card Surg. 2021;36(4):1258-1263. doi: 10.1111/jocs.15357

43. Berns S.A., Shmidt E.A., Nagirniyak O.A. Management of patients with pulmonary embolism in the cardiac hospital from positions of modern european society of cardiology guidelines. Complex Issues of Cardiovascular Diseases. 2015;(4):90-96. (In Russ.). doi:10.17802/2306-1278-2015-4-90-96