Abstract 46: Outcome And Quality Of Life After Central Pulmonary Embolism: Surgical Embolectomy Versus Medical Treatment
Background: Therapy of massive pulmonary embolism is still a matter of debate. In tertiary centres different modality of treatments are available. Aim of the present study was to assess outcome and mid-term quality of life (QoL) of patients with massive central pulmonary embolism treated either by surgical embolectomy (SE) or thrombolytic agents (TA).
Methods: 69 patients with central pulmonary embolism and severely haemodynamic compromised have been identified. 19 patients (27.5%) were treated by SE and the remaining patients with TA. All the in-hospital data have been assessed and a follow-up, focussing on outcome and quality of life, was made.
Results: The surgical collective was younger (57.9±14.9 y vs. 63.1±16.9; p<0.05) and more symptomatic at the time of diagnosis, with a Schock-Index: of 0.9±0.4 vs. 1.3±0.5 (p<0.05) and a pCO2 of 50.3±19.5mmHg vs. 36.7±12.2mmHg (p<0.05) in patients treated with TA. Early mortality was similar in both collectives (SE: 5.3% vs. TA: 7.1%; p=ns) as well as follow-up survival after an average follow-up 33.2±12.3 months (SE: 68.4% vs. TA 66.1%; p=ns). 2 patients in the TA-group were hospitalized due to a massive pulmonary embolism in the follow-up. 89.7% in the SE-group are under oral anticoagulation, compared to 81.8% in the TA-group (p=ns). No anticoagulation-related complications have been reported in the follow-up. Average age- and gender-matched quality of life was similar in both groups (SE: 85.7 vs. TA 85.0; p=ns). Patients treated with TA reported a significant higher level of fear, than patients treated with SE.
Conclusions: SE is an excellent therapy of central pulmonary embolism in haemodynamic compromised patients. Despite being more symptomatic early and mid-term outcome was similar in both groups. Follow-up revealed that age and gender matched QoL is preserved in both groups. However, patients treated with TA are much more scared than patients who underwent surgery.