OBJECTIVES
The presence of right heart thrombi in transit in the setting of acute pulmonary embolism is associated with high mortality. The optimal management in such cases is inconclusive. We present the results of surgical treatment of 20 consecutive patients diagnosed with high or intermediate-high risk pulmonary embolism with coexisting right heart thrombi in transit.
METHODS
A retrospective analysis was performed of all consecutive patients undergoing surgical treatment in the Medicover Hospital between 2013 and 2021 for acute pulmonary embolism with coexisting thrombi in-transit in right heart cavities. The diagnosis was based on echocardiography, computed tomography pulmonary angiography, and laboratory tests. Eligibility criteria for surgical treatment were acute pulmonary embolism with right heart thrombi in transit, right ventricular overload on imaging studies, and significantly elevated levels of cardiac troponin and NTproBNP. All patients were operated on with extracorporeal circulation using deep hypothermia and total circulatory arrest. The primary end-point was hospital all-cause mortality; secondary end-points were perioperative complications and long-term mortality.
RESULTS
The analysis included 20 patients. There was no in-hospital death. Nearly one-third of patients required temporal hemofiltration for postoperative renal failure, but this did not involve the need for dialysis at discharge. No neurological complications occurred in any patient. The mean follow-up was 46 months (range 13-98). There was one death in the long-term follow-up, not related to pulmonary embolism.
CONCLUSIONS
Surgical treatment of patients with acute pulmonary embolism and coexisting right heart thrombi in transit can provide favourable results.