Surgical treatment of acute pulmonary embolism: a modified surgical technique to avoid deep hypothermia and circulatory arrest

Abstract

: Massive acute pulmonary embolism (MAPE) is a rare and life-threatening condition that cardiothoracic surgeons may face during their clinical practice. As considerable improvements have been made in pharmacological and interventional treatment, MAPE is usually treated nonsurgically. A surgical approach, even if it is proven to be a good and efficacious alternative to thrombolysis, is considered only after a failure of the medical therapy or in the presence of massive occlusion of the main branches of the pulmonary arteries. In order to achieve a good and bloodless view of the operative field, some cardiothoracic surgeons prefer to treat this condition adopting the same technique used for chronic pulmonary embolism recurring to deep hypothermia and circulatory arrest; however, this approach usually leads to neurologic or splanchnic hypoperfusion problems. We here describe a modified surgical technique that does not require deep hypothermia or circulatory arrest, the consequences of which are reductions in surgery time and the postoperative recovery period in the intensive care unit (ICU). Shorter cardiopulmonary bypass times allow for lower hemodilution levels and a decreased inflammatory response, which in turn leads to a decreased risk of cerebral, lung and renal edema and quicker discharge from the ICU.