THREE-YEAR RESULTS OF MEDICAL AND SURGICAL REPERFUSIONAL TREATMENT OF PATIENTS TRANSPOSED BY THROMBOEMBOLIA OF PULMONARY ARTERY: OUTCOME, CLINICAL STATUS, STATE OF PULMONARY PERFUSION

The purpose. To estimate hospital and three-year results of reperfusion treatment in pulmonary embolism (PE) patients.

Methods. One-center prospective study included 30 patients with intermediate high-risk and high-risk acute PE that had indications for reperfusion: thrombolytic therapy (TLT) and / or surgical thrombectomy. The endpoints of the study in the hospital and long-term follow-up period were such unfavorable cardiovascular events as death, myocardial infarction, acute cerebrovascular accident / transient ischemic attack, re-PE.

Results. It was shown that reperfusion treatment had satisfactory rates of hospital survival (97%), efficacy, with significant regression of clinical symptoms and pulmonary hypertension (from 56.93 ± 17.18 to 36.72 ± 14.47 mm Hg.). There was a significant decrease of tricuspid insufficiency (from 77% initially to 24% at the time of discharge) (p <0.05). After 3 years, the rate of fatal outcomes reached 33%, most of which occurred in the TLT group and was associated with re-PE. Fifty fife percent of the surviving patients had pulmonary hypertension, 15% had major or segmental perfusion defects according to perfusion lung scintigraphy (PSL) data.

Conclusion. The presence of significant pulmonary perfusion defects according to the results of PSL in one out of seven surviving patients in more than half of the cases is likely to be a result of insufficiently frequent use of the surgical option of treatment in clinical practice. The high frequency of fatal outcomes in the long-term follow-up period, realized through re-PE, indicates insufficient compliance of patients to medical therapy. 

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