Off-Pump Open Pulmonary Embolectomy for Patients with Major Pulmonary Embolism


  • Young Jo Sa
  • Si Young Choi
  • Jong Ho Lee
  • Jong Beom Kwon
  • Seok Whan Moon
  • Keon Hyeon Jo
  • Young Pil Wang
  • Seok Chan Kim
  • Pum Jun Kim
  • Hae Ok Jung



Acute major pulmonary artery embolism (AMPE) requires rapid diagnosis and early intensive treatment to optimize patient outcomes. Most patients with AMPE and hemodynamic instability need open pulmonary embolectomy (OPE). We modified the technique of OPE to include a minimally invasive procedure without the use of cardiopulmonary bypass (CPB). From March 1988 to April 2006, we performed OPE on a total of 12 patients (21 sides) with AMPE. Seven patients (13 sides) underwent conventional OPE with CPB and 5 patients underwent off-pump OPE (OPPE), 4 (8 sides) with AMPE and 1 with catheter embolus with thrombosis. In patients who underwent conventional OPE, there was 1 hospital death in a patient with severe right ventricle dysfunction and 2 significant cases of airway bleeding. In patients who underwent OPPE, there was 1 case of minimal airway bleeding. Mean systolic pulmonary artery pressure in conventional OPE and OPPE patients, respectively, decreased from 50.3 ± 14 mmHg and 35.4 ± 6.6 mmHg pre-operatively to 41.7 ± 20 and 28 ± 3 mmHg postoperatively. During the long-term follow-up, there were 2 cancer-related deaths but no recurrence of PE. All surviving patients maintained functional class I (n = 10) or II (n = 1). Compared with conventional OPE, OPPE was effective for treating AMPE in our selected cases. Modification of conventional CPB and systemic full heparinization to minimal use of systemic heparinization without CPB may be helpful in treating selected patients with AMPE.


Ashrafian H, Kumar P, Athanasiou T, et al. 2003. Minimally invasive off-pump pulmonary embolectomy. Cardiovasc Surg11(6):471-3.nBarbosa G, Saccani S, Fragnito C, et al. 1995. Unilateral pulmonary embolectomy without extracorporeal circulation. A report of a clinical case. Acta Biomed Ateneo Parmense66(1-2):53-5.nClarke DB, Abrams LD. 1986. Pulmonary embolectomy: a 25 year experience. J Thorac Cardiovasc Surg92:442-5.nDauphine C, Omari B. 2005. Pulmonary embolectomy for acute massive pulmonary embolism. Ann Thorac Surg79:1240-4.nEng J, Krishnan JA, Segal JB, et al. 2004. Accuracy of CT in the diagnosis of pulmonary embolism: a systematic literature review. AJR183:1819-27.nGoldhaber SZ, Visani L, De Rosa M. 1999. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet353(9162):1386-9.nGulba DC, Schmid C, Borst HG, et al. 1994. Medical compared with surgical treatment for massive pulmonary embolism. Lancet343:576-7.nHirnle T, Hirnle G. 2004. A case of surgical treatment of acute pulmonary embolism without the use of extracorporeal circulation. Surgery135(4):461-2.nHsieh PC, Wang SS, Ko WJ, et al. 2001. Successful resuscitation of acute massive pulmonary embolism with extracorporeal membrane oxygenation and open embolectomy. Ann Thorac Surg72(1):266-7.nIchimanda M, Fujiwara S, Yoshimatsu T. 2000. A case report of pulmonary embolectomy for acute pulmonary thromboembolism without extra-corporeal circulation. Kyobu Geka53(1):56-9.nKasper W, Konstantinides, Geiblel A, et al. 1997. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol30(5):1165-71.nKucher N, Rossi E, BS, Rosa MD, et al. 2006. Massive pulmonary embolism. Circulation113:577-82.nLeacche M, Unic D, Goldhaber SZ, et al. 2005. Modern surgical treatment of massive pulmonary embolism: results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach. J Thorac Cardiovasc Surg129(5):1018-23.nMeyer G, Tamisier D, Sors H, et al. 1991. Pulmonary embolectomy: a 20-year experience at one center. Ann Thorac Surg51:232-6.nMoon SW, Jo KH, Wang YP, et al. 2006. Off-pump open pulmonary embolectomy for major bilateral pulmonary emboli: report of a case. Surg Today36(3):274-6.nSchmid C, Zietlow S, Wagner T, et al. 1991. Fulminant pulmonary embolism: symptoms, diagnostic, operative technique and results. Ann Thorac Surg52(5):1102-5.nSchoepf UJ, Kucher N, Kipfmueller F, et al. 2004. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation110:3276-80.nSenning A. 1998. Left anterior thoracotomy for pulmonary embolectomy with 29-year follow-up. Ann Thorac Surg66(4):1420-1.nStulz P, Schlapfer R, Habicht J, et al. 1994. Decision making in the surgical treatment of massive pulmonary embolism. Eur J Cardiothorac Surg8:188-93.nSudo K, Ide H, Fujiki T, et al. 1999. Pulmonary embolectomy for acute massive pulmonary embolism under percutaneous cardiopulmonary support. J Cardiovasc Surg (Torino)40(1):165-7.nVossschulte K, Stiller H, Eisenreich F. 1965. Emergency embolectomy by the transsternal approach in acute pulmonary embolism. Surgery58:317-23.nYalamanchili K, Fleisher AG, Lehrman SG, et al. 2004. Open pulmonary embolectomy for treatment of major pulmonary embolism. Ann Thorac Surg77:819-23.n



How to Cite

Sa, Y. J., Choi, S. Y., Lee, J. H., Kwon, J. B., Moon, S. W., Jo, K. H., Wang, Y. P., Kim, S. C., Kim, P. J., & Jung, H. O. (2007). Off-Pump Open Pulmonary Embolectomy for Patients with Major Pulmonary Embolism. The Heart Surgery Forum, 10(4), E304-E308.




Most read articles by the same author(s)