More patients may benefit from pulmonary embolism surgery

A new scientific statement from the American Heart Association presents evidence that patients at higher risk of pulmonary embolism may benefit from surgical management, suggesting that a refined definition of risk level could be used to determine which It may help identify which patients will benefit.¹

Pulmonary embolism, a blood clot that travels to the lungs, is the third leading cause of cardiovascular death in the United States. In approximately 45% of patients experiencing pulmonary embolism, the clot causes high pressure in the lungs, which subsequently damages the right ventricle and progresses to severe disease with a high risk of death. Mortality is high, even with treatment according to current guidelines, with approximately 40% of cases occurring in some patient populations.¹

Treatment options include anticoagulant and thrombolytic therapy, or advanced surgical interventions such as surgical embolectomy and mechanical circulatory support. Although surgical procedures are often used as a last resort after other treatments have failed, this statement suggests that early consideration of surgery may improve survival in patients with severe pulmonary embolism. suggests that it may be useful for¹

“This statement demonstrates that modern surgical management strategies and mechanical circulatory support can result in excellent survival rates (97%) for even the sickest patients, including those presenting in cardiac arrest and undergoing CPR. Press release by the statement writing group and attending cardiothoracic surgeon at the Westchester Cardiovascular Center in Valhalla, NY.¹

The writing group proposes strategies to more accurately determine pulmonary embolism risk and identify which patients would benefit earlier from surgical intervention. They also suggest strengthening clinician education to encourage the use and integration of surgical strategies early in treatment.¹

According to the statement, the reported literature on surgical and mechanical perfusion reviewed by the authors represents the most robust data on the high-risk pulmonary embolism population.²

The authors found that surgical embolectomy and venous-arterial extracorporeal membrane oxygenation (VA-ECMO) have favorable safety and efficacy profiles when considering baseline levels of disease in the population in which they are used. found to show Surgical embolectomy mortality for patients who do not require preoperative CPR is less than 3%, and survival for patients who require CPR is approximately 75%.²

Similarly, VA-ECMO is used for the most critically ill patients in high-risk populations, most of whom require preoperative CPR, but with reported short-term survival rates of approximately 70%.²

“Based on the aforementioned result data, [surgical embolectomy] When [mechanical circulatory support] It may offer additional survival benefits in populations where current treatment paradigms continue to be associated with very high mortality,” the authors wrote in a statement.²

This statement also supports the development of patient registries, particularly in context to help clinicians and surgeons understand the progression of intermediate- to high-risk pulmonary embolism and the outcome of treatment for patients with different risk levels. We focus on data that provide¹

“Modern surgical strategies and mechanical circulatory support are largely underutilized,” Goldberg said in a press release. “We hope that this scientific statement will raise awareness about the safety and effectiveness of modern surgical management and mechanical circulatory support in treating the most vulnerable patients, so that they can save lives. , the interdisciplinary group of authors hopes, further, that this statement will advance our understanding of the disease process and effective treatments to improve the survival of patients with this common and deadly disease. We hope that it will facilitate future research in

References

1. New statement suggests more patients may benefit from surgery for pulmonary embolism. News release. American Heart Association; January 23, 2023. Accessed January 23, 2023. https://newsroom.heart.org/news/new-statement-suggests-more-patients-may-benefit-from-surgery-for-pulmonary-embolism?preview=7e29
2. Goldberg JB, Giri J, Kobayashi T, Rual M, et al. Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolism: Historical Background, Current Status, and Future Directions: A Scientific Statement from the American Heart Association. statement. circulation.2023;1 47:00-00. doi:10.1161/CIR.00000000001117.