Reply

Abstract

We thank Drs Ozcinar and colleagues [1Ozcinar E. Erol S. Aliyev A. Cakici M. Baran C. Bermede O. Could surgical pulmonary embolectomy be performed with acceptable outcomes without a pulmonary embolism response team?.Ann Thorac Surg. 2017; 104 (letter): 1432Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] for their interest in our article “Outcomes after surgical pulmonary embolectomy for acute pulmonary embolus: a multi-institutional study” [2Keeling B.W. Sundt T. Leacche M. et al.Outcomes after surgical pulmonary embolectomy for acute pulmonary embolus: a multi-institutional study.Ann Thorac Surg. 2016; 102: 1498-1502Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar]. They pose many interesting points in their correspondence, and we aim to clarify some issues as possible. Given that this was a retrospective, multiinstitutional study using prospectively maintained databases, individual chart review was not possible. For instance, the duration from diagnosis to treatment of life-threatening pulmonary emboli is not usually captured in most databases, and it was a variable not available to us in this study. One of the noted limitations (but also one of the strengths) of this study is that it was a multiinstitutional one, and different clinical scenarios are handled in different manners across the four institutions that participated. This study was designed only to prove that surgical pulmonary embolectomy was safe in multiple institutions, and we believe that it did. It was not designed to evaluate right ventricular hemodynamics as measured by echocardiography, and that is certainly an area for future study. We certainly agree that the use of extracorporeal membrane oxygenation will help bridge patients in a hemodynamically unstable condition who experience massive pulmonary emboli to the correct treatment algorithm. This technology should no doubt be increasingly used. Last, algorithmic treatment of all patients who experience life-threatening pulmonary emboli is a lofty goal. Too often, these patients present with other medical problems (ie, terminal cancer, pregnancy, chronic pulmonary thromboembolic disease) that significantly complicate care and limit the therapeutic options, thus rendering many algorithms useless. Surgeons must be increasingly involved at the local level in the care of these patients. Without increased involvement, surgical pulmonary embolectomy will be used sparingly and only on moribund patients. As our data demonstrated, surgical pulmonary embolectomy is safe for the treatment of life-threatening pulmonary emboli and, given the poor short-term outcomes of other therapies, should likely be increasingly used. Could Surgical Pulmonary Embolectomy Be Performed With Acceptable Outcomes Without a Pulmonary Embolism Response Team?The Annals of Thoracic SurgeryVol. 104Issue 4PreviewWe read the article by Keeling and colleagues [1] with great interest. Patients with pulmonary emboli (PE) continue to be treated conservatively, and this has prompted alternative therapies. This study suggested that the embolectomy procedure should be included in the treatment of PE. Full-Text PDF