Management of acute massive pulmonary embolism: Is surgical embolectomy inferior to thrombolysis?

Background: Although current guidelines for pulmonary embolism (PE) treatment recommend surgical embolectomy when thrombolysis is contraindicated or has failed, their clinical outcomes rarely have been compared directly. Methods: After excluding patients aged under 18 years and those with submassive or non-massive PE, 45 consecutive patients (median age, 68 years; 62% female; 31% experienced cardiac arrest before PE treatment onset; 33% had cancer diagnosis history; and 29% received extracorporeal membrane oxygenation [ECMO]) who underwent only thrombolysis (TL group; n=19) or surgical embolectomy (SE group; n= 26, including 4 who had failed thrombolysis) for acutemassive PE from 2000 to 2013 at Samsung Medical Center were enrolled to assess cardiac mortality as primary outcome. Results: Median follow-up duration was 17.2 months. In the SE group, significantly higher proportions of patients had recent surgery and ECMO. Overall 30-day all-cause mortality rate was 24% (n= 11), without significant difference between the SE (15%) and TL (37%) groups (P = 0.098); however, cardiac mortality rate was significantly higher in the TL than SE group (Log rank P = 0.023). TL was an independent multivariate predictor of cardiac death (P=0.03). Conclusion: In this small retrospective single center experience, surgical embolectomy is associated with lower cardiac mortality risk than thrombolysis, which might render it first-line treatment option for acute massive PE for patients without life-limiting comorbidities. (C) 2015 Elsevier Ireland Ltd. All rights reserved.