PMID- 23677779
OWN - NLM
STAT- MEDLINE
DCOM- 20140220
LR  - 20211021
IS  - 1569-9285 (Electronic)
IS  - 1569-9293 (Print)
IS  - 1569-9285 (Linking)
VI  - 17
IP  - 2
DP  - 2013 Aug
TI  - Residual pulmonary hypertension after retrograde pulmonary embolectomy: long-term 
      follow-up of 30 patients with massive and submassive pulmonary embolism.
PG  - 242-6
LID - 10.1093/icvts/ivt210 [doi]
AB  - OBJECTIVES: Pulmonary hypertension is a major cause of morbidity and mortality in 
      patients following acute pulmonary embolism. Although thrombolytic therapy 
      decreases pulmonary arterial pressure, compared with anticoagulation alone, it 
      has the propensity for haemorrhagic complications, distal embolization and 
      incomplete recanalization, with the potential risk of late pulmonary 
      hypertension. Surgical embolectomy-once performed solely on critically-ill 
      patients-has now gained favour in a wider range of patients. In this paper we 
      present the outcomes of patients who underwent surgical embolectomy complemented 
      with retrograde technique and follow-up systolic pulmonary arterial pressure 
      (SPAP). METHODS: From January 2004 to December 2010, 30 consecutive patients with 
      a mean age of 58+/-15 years underwent pulmonary embolectomy at our centre. The 
      patients were followed for a mean period of 30.5+/-12 months. Their New York Heart 
      Association (NYHA) classifications were assessed and their SPAPs were measured by 
      echocardiography. RESULTS: The overall mortality rate was 13.2% (4/30). Of the 
      remaining patients, 19 patients (73.1%) were in NYHA classes I and II, 7 patients 
      (26.9%) in class III and no patient in class IV. The patients' preoperative and 
      postoperative mean SPAPs were 44.9+/-5.7 and 34.9+/-7.1 mmHg, respectively, which 
      showed a significant reduction (P<0.001). The mean SPAP in the follow-up was 
      29.4+/-11.5 mmHg, which again showed significant reduction compared with early 
      postoperation values (P<0.001). No significant correlations were found between 
      the level of SPAP reduction in patients' follow-up with age (P=0.727) and total 
      days of ICU admission (P=0.700), but weak correlations with sex (P=0.016) and 
      total intubation time were noticed (P=0.035). CONCLUSIONS: This is the first 
      series reporting the long-term outcome of patients undergoing surgical 
      embolectomy complemented by retrograde embolectomy technique, demonstrating the 
      safety and favourable long-term outcome of this technique. It is also a new 
      element in the growing body of evidence regarding the relevance of surgical 
      embolectomy in patients with acute pulmonary embolism. We concluded that, 
      following surgery, not only does the pulmonary arterial pressure drop 
      immediately, but also the trend toward normalization continues long after 
      operation.
FAU - Zarrabi, Khalil
AU  - Zarrabi K
AD  - Department of Cardiac Surgery, School of Medicine, Shiraz University of Medical 
      Sciences, Shiraz, Iran.
FAU - Zolghadrasli, Abdolali
AU  - Zolghadrasli A
FAU - Ali Ostovan, Mohammad
AU  - Ali Ostovan M
FAU - Azimifar, Azimeh
AU  - Azimifar A
FAU - Malekmakan, Leila
AU  - Malekmakan L
LA  - eng
PT  - Journal Article
DEP - 20130514
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
SB  - IM
CIN - Interact Cardiovasc Thorac Surg. 2013 Aug;17(2):246. PMID: 23868961
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Arterial Pressure
MH  - *Embolectomy/adverse effects/mortality
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/diagnosis/etiology/mortality/physiopathology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Artery/diagnostic imaging/physiopathology/*surgery
MH  - Pulmonary Embolism/complications/diagnosis/mortality/*surgery
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ultrasonography
PMC - PMC3715199
OTO - NOTNLM
OT  - Acute pulmonary embolism
OT  - Chronic thrombo-embolic pulmonary hypertension
OT  - Retrograde pulmonary embolectomy
OT  - Surgical pulmonary embolectomy
EDAT- 2013/05/17 06:00
MHDA- 2014/02/22 06:00
PMCR- 2014/08/01
CRDT- 2013/05/17 06:00
PHST- 2013/05/17 06:00 [entrez]
PHST- 2013/05/17 06:00 [pubmed]
PHST- 2014/02/22 06:00 [medline]
PHST- 2014/08/01 00:00 [pmc-release]
AID - ivt210 [pii]
AID - 10.1093/icvts/ivt210 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2013 Aug;17(2):242-6. doi: 10.1093/icvts/ivt210. 
      Epub 2013 May 14.