Outcomes of pulmonary embolectomy for acute pulmonary embolism

Japan Cardiovascular Surgery Database Organization

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Acute pulmonary embolism (PE) is a major threat to the health and lives of hospitalized patients. This study was conducted to clarify the real-world outcomes of pulmonary embolectomy. Methods and Results: Retrospective investigation of 355 patients who underwent pulmonary embolectomy for acute PE was conducted using the Japanese Cardiovascular Surgery Database. Risk factors for operative death within 30 days after pulmonary embolectomy and major adverse cardiovascular events (MACE), including operative death, postoperative stroke and postoperative coma, were analyzed. Cardiopulmonary resuscitation (CPR) was required preoperatively in 27.6%, and preoperative veno-arterial extracorporeal membrane oxygenation was performed in 26.5%. Urgent or emergency operation was performed in 93% of patients. Operative mortality rate was 73/355 (20.6%). Incidence of MACE was 97/355 (27.3%). In univariate analysis, preoperative predictors of death were obesity, renal dysfunction, chronic obstructive pulmonary disease, liver injury, recent myocardial infarction, shock, refractory shock, CPR, heart failure, inotrope use, poor left ventricular function, preoperative arrhythmia and tricuspid regurgitation. In multivariate analysis, independent risk factors for operative death were heart failure (P=0.013), poor left ventricular function (P=0.007), and respiratory failure (P=0.001). Poor left ventricular function (P=0.033), preoperative CPR (P=0.002) and respiratory failure (P=0.007) were independent risk factors for MACE. Conclusions: The outcomes of pulmonary embolectomy were acceptable, considering the urgency and preoperative comorbidities of patients. Early triage of patients with hemodynamically unstable PE is important.

Original languageEnglish
Pages (from-to)2184-2190
Number of pages7
JournalCirculation Journal
Volume82
Issue number8
DOIs
Publication statusPublished - 2018 Jan 1
Externally publishedYes

Fingerprint

Embolectomy
Pulmonary Embolism
Cardiopulmonary Resuscitation
Lung
Left Ventricular Function
Respiratory Insufficiency
Shock
Heart Failure
Tricuspid Valve Insufficiency
Extracorporeal Membrane Oxygenation
Triage
Coma
Chronic Obstructive Pulmonary Disease
Comorbidity
Cardiac Arrhythmias
Emergencies
Multivariate Analysis
Obesity
Stroke
Myocardial Infarction

Keywords

  • Acute pulmonary embolism
  • Percutaneous cardiopulmonary support
  • Pulmonary embolectomy
  • Shock
  • VA-ECMO

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Japan Cardiovascular Surgery Database Organization (2018). Outcomes of pulmonary embolectomy for acute pulmonary embolism. Circulation Journal, 82(8), 2184-2190. https://doi.org/10.1253/circj.CJ-18-0371

Outcomes of pulmonary embolectomy for acute pulmonary embolism. / Japan Cardiovascular Surgery Database Organization.

In: Circulation Journal, Vol. 82, No. 8, 01.01.2018, p. 2184-2190.

Research output: Contribution to journalArticle

Japan Cardiovascular Surgery Database Organization 2018, 'Outcomes of pulmonary embolectomy for acute pulmonary embolism', Circulation Journal, vol. 82, no. 8, pp. 2184-2190. https://doi.org/10.1253/circj.CJ-18-0371
Japan Cardiovascular Surgery Database Organization. Outcomes of pulmonary embolectomy for acute pulmonary embolism. Circulation Journal. 2018 Jan 1;82(8):2184-2190. https://doi.org/10.1253/circj.CJ-18-0371
Japan Cardiovascular Surgery Database Organization. / Outcomes of pulmonary embolectomy for acute pulmonary embolism. In: Circulation Journal. 2018 ; Vol. 82, No. 8. pp. 2184-2190.
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abstract = "Background: Acute pulmonary embolism (PE) is a major threat to the health and lives of hospitalized patients. This study was conducted to clarify the real-world outcomes of pulmonary embolectomy. Methods and Results: Retrospective investigation of 355 patients who underwent pulmonary embolectomy for acute PE was conducted using the Japanese Cardiovascular Surgery Database. Risk factors for operative death within 30 days after pulmonary embolectomy and major adverse cardiovascular events (MACE), including operative death, postoperative stroke and postoperative coma, were analyzed. Cardiopulmonary resuscitation (CPR) was required preoperatively in 27.6{\%}, and preoperative veno-arterial extracorporeal membrane oxygenation was performed in 26.5{\%}. Urgent or emergency operation was performed in 93{\%} of patients. Operative mortality rate was 73/355 (20.6{\%}). Incidence of MACE was 97/355 (27.3{\%}). In univariate analysis, preoperative predictors of death were obesity, renal dysfunction, chronic obstructive pulmonary disease, liver injury, recent myocardial infarction, shock, refractory shock, CPR, heart failure, inotrope use, poor left ventricular function, preoperative arrhythmia and tricuspid regurgitation. In multivariate analysis, independent risk factors for operative death were heart failure (P=0.013), poor left ventricular function (P=0.007), and respiratory failure (P=0.001). Poor left ventricular function (P=0.033), preoperative CPR (P=0.002) and respiratory failure (P=0.007) were independent risk factors for MACE. Conclusions: The outcomes of pulmonary embolectomy were acceptable, considering the urgency and preoperative comorbidities of patients. Early triage of patients with hemodynamically unstable PE is important.",
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AU - Japan Cardiovascular Surgery Database Organization

AU - Minakawa, Masahito

AU - Fukuda, Ikuo

AU - Miyata, Hiroaki

AU - Motomura, Noboru

AU - Takamoto, Shinichi

AU - Taniguchi, Satoshi

AU - Daitoku, Kazuyuki

AU - Kondo, Norihiro

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N2 - Background: Acute pulmonary embolism (PE) is a major threat to the health and lives of hospitalized patients. This study was conducted to clarify the real-world outcomes of pulmonary embolectomy. Methods and Results: Retrospective investigation of 355 patients who underwent pulmonary embolectomy for acute PE was conducted using the Japanese Cardiovascular Surgery Database. Risk factors for operative death within 30 days after pulmonary embolectomy and major adverse cardiovascular events (MACE), including operative death, postoperative stroke and postoperative coma, were analyzed. Cardiopulmonary resuscitation (CPR) was required preoperatively in 27.6%, and preoperative veno-arterial extracorporeal membrane oxygenation was performed in 26.5%. Urgent or emergency operation was performed in 93% of patients. Operative mortality rate was 73/355 (20.6%). Incidence of MACE was 97/355 (27.3%). In univariate analysis, preoperative predictors of death were obesity, renal dysfunction, chronic obstructive pulmonary disease, liver injury, recent myocardial infarction, shock, refractory shock, CPR, heart failure, inotrope use, poor left ventricular function, preoperative arrhythmia and tricuspid regurgitation. In multivariate analysis, independent risk factors for operative death were heart failure (P=0.013), poor left ventricular function (P=0.007), and respiratory failure (P=0.001). Poor left ventricular function (P=0.033), preoperative CPR (P=0.002) and respiratory failure (P=0.007) were independent risk factors for MACE. Conclusions: The outcomes of pulmonary embolectomy were acceptable, considering the urgency and preoperative comorbidities of patients. Early triage of patients with hemodynamically unstable PE is important.

AB - Background: Acute pulmonary embolism (PE) is a major threat to the health and lives of hospitalized patients. This study was conducted to clarify the real-world outcomes of pulmonary embolectomy. Methods and Results: Retrospective investigation of 355 patients who underwent pulmonary embolectomy for acute PE was conducted using the Japanese Cardiovascular Surgery Database. Risk factors for operative death within 30 days after pulmonary embolectomy and major adverse cardiovascular events (MACE), including operative death, postoperative stroke and postoperative coma, were analyzed. Cardiopulmonary resuscitation (CPR) was required preoperatively in 27.6%, and preoperative veno-arterial extracorporeal membrane oxygenation was performed in 26.5%. Urgent or emergency operation was performed in 93% of patients. Operative mortality rate was 73/355 (20.6%). Incidence of MACE was 97/355 (27.3%). In univariate analysis, preoperative predictors of death were obesity, renal dysfunction, chronic obstructive pulmonary disease, liver injury, recent myocardial infarction, shock, refractory shock, CPR, heart failure, inotrope use, poor left ventricular function, preoperative arrhythmia and tricuspid regurgitation. In multivariate analysis, independent risk factors for operative death were heart failure (P=0.013), poor left ventricular function (P=0.007), and respiratory failure (P=0.001). Poor left ventricular function (P=0.033), preoperative CPR (P=0.002) and respiratory failure (P=0.007) were independent risk factors for MACE. Conclusions: The outcomes of pulmonary embolectomy were acceptable, considering the urgency and preoperative comorbidities of patients. Early triage of patients with hemodynamically unstable PE is important.

KW - Acute pulmonary embolism

KW - Percutaneous cardiopulmonary support

KW - Pulmonary embolectomy

KW - Shock

KW - VA-ECMO

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