Aggressive approach to pulmonary embolectomy for massive acute pulmonary embolism: a historical and contemporary perspective.

摘要

In this issue of Mayo Clinic Proceedings, Sareyyupoglu et al1 of Mayo Clinic describe a series of 18 patients who had aggressive surgical treatment for acute pulmonary embolism (PE). The authors were careful to define the presence of cardiogenic shock and severe right ventricular dysfunction as indications for urgent surgical embolec-tomy in these critically ill patients. The surgical technique used for acute pulmonary embolectomy is a variation of the modified Trendelenburg procedure used by many surgeons.24 Specifically, the operation was conducted through a median sternotomy with aortic and bicaval cannulation and normothermic cardiopulmonary bypass. Incisions into the main pulmonary artery to remove the clot were extended into the distal pulmonary arteries when necessary.