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Outcomes of Surgical Pulmonary Embolectomy by Severity and Race
Brandon Peine1, Seth Quinn1, O Jesse Mendes1, Scarlett Hao1, Shahab Akhter2.
1Department of Surgery - East Carolina University, Greenville, NC, USA, 2East Carolina Heart Institute, Greenville, NC, USA.

BACKGROUND: Surgical embolectomy for pulmonary embolism (PE), previously reserved for extreme cases, has historically poor outcomes. It remains underutilized despite recent reports of favorable outcomes. The primary aim was to assess for surgical outcomes in patients with less severe PE as well as for racial disparity.
METHODS: Patients who underwent pulmonary embolectomy from 2008-2020 at a single institution were stratified into three cohorts: submassive PE defined as right ventricular dysfunction (RVD) without hemodynamic instability, massive PE defined as RVD with hemodynamic instability without arrest, and massive PE with arrest. Patients were also stratified by race. Post-operative complications and mortality were compared between groups.
RESULTS: Out of 48 patients, 44% (21) had submassive PE, 42% (20) had massive PE without arrest, and 15% (7) had massive PE with arrest. Mean age was 54 (SD 15.3). 56% (27) of patients were Black and 44% (21) White. Postoperative complications included 4% (2) with post-operative stroke, 6% (3) with new-onset renal failure requiring dialysis, and 8% (4) with multi-system organ failure. 30-day mortality was 13% (6) overall, 5% (1) submassive PE, 10% (2) massive PE without arrest, and 43% (3) massive PE with arrest. When controlling for age, sex, and severity, there were no significant differences between racial cohorts in post-operative complications or 30-day mortality.
CONCLUSIONS: Surgical pulmonary embolectomy appears to be an effective treatment in patients with less severe PE, without racial differences in outcomes. Surgical pulmonary embolectomy should be considered for patients with submassive and massive PE without arrest.


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