Abstract
Current treatment of life threatening venous thrombo-embolism (VTE) has been based on general concepts dating to the early 1900s. In this manuscript a general overview of current diagnostic and therapeutic methods of VTE is presented along with the Emory University Affiliated Hospitals’ experience of the surgical treatment of life threatening VTE. We retrospectively analyzed the data of twenty-seven consecutive patients who underwent pulmonary embolectomy on cardiopulmonary bypass from January 1998 through April 2010. Our results showed successful outcomes after urgent or emergent surgical pulmonary embolectomy. It encourages the choice of an early and aggressive surgical approach for large pulmonary emboli in hemodynamically unstable patients.
Highlights
Modern day approach for the treatment of life threatening venous thrombo-embolism (VTE) dates back to over a hundred years ago and is intertwined with the history of cardio-pulmonary bypass technology and the beginning of surgical operations on the heart
Our results showed successful outcomes after urgent or emergent surgical pulmonary embolectomy
Life Threatening Pulmonary Embolism (LTPE) is defined as acute systemic dysfunction secondary to large veno-thrombo pulmonary embolus associated with hemodynamic instability associated with blood pressure lower than 90 mm·Hg [5]
Summary
Modern day approach for the treatment of life threatening venous thrombo-embolism (VTE) dates back to over a hundred years ago and is intertwined with the history of cardio-pulmonary bypass technology and the beginning of surgical operations on the heart. Frustrated by the high mortality rate and dismal outcome of the Trendelenburg procedure with only nine out of 142 patients treated for massive pulmonary emboli, innovative and pioneer surgeon John Gibbon initiated focused work to address this dismal outcome of the Trendelenburg procedure which led to him inventing and developing the heart lung machine and oxygenator [3]. This historic invention ushered modern era of cardiac surgery. Sharp in 1962, was the first to successfully perform pump supported pulmonary embolectomy [4]
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