Abstract 18040: Advanced Treatment of Submassive Pulmonary Embolism in 135 Patients Triaged by a Multidisciplinary Pulmonary Embolism Response Team
Introduction: Acute pulmonary embolism (PE) with hemodynamic stability and right ventricular(RV) dysfunction carries a high risk of mortality and is classified as submassive PE(SMPE). We report the results of a multidisciplinary PE team approach for treatment of SMPE with surgical pulmonary embolectomy(SPE) and catheter-directed thrombolysis(CDT).
Methods: Data were collected for patients who underwent SPE or CDT for SMPE from January 2002- May 2015. Our multidisciplinary team consists of cardiologists, cardiac surgeons, and interventional cardiologists who determine on a case-by-case basis the optimal advanced treatment strategy. The EkoSonic ultrasound-assisted system was used for CDT.
Results: 135 patients underwent treatment for SMPE; 71 underwent SPE, and 64 had CDT. Mean age was 57.3±14 years, and 49/135(36.3% were female. Identified risk factors for PE included DVT 59/135(43.7%), immobility 48/135(35.8%), and cancer 31/135(23.2%). In patients with prohibitive risk for surgery(58/64; 91%) or distal/diffuse clot(6/64; 9.4%), CDT was utilized. For SPE patients, 2.8%(2/71) had clot-in-transit, and 47%(33/71) had contraindications to thrombolysis such as recent surgery 17/71(24%), active bleeding 6/71 (8.5%), or intracranial pathology 10/71(14%). Overall operative mortality was 5.2%(SPE 7.0% vs CDT 3.1%, p=0.44). Bleeding complications were observed in 6 CPT patients(9.4%) and none in SPE(p=0.010). Postoperative stroke rate was 1.5%(2/135), all in SPE group(p=0.50). CDT patients had shorter ICU(20hrs vs 70hrs, p<0.001) and hospital LOS(3d vs 8d, p<0.001). Four-year survival was 85% for the entire cohort(Figure).
Conclusion: Management of acute submassive PE by a multidisciplinary PE team results in low mortality and complication rates. SPE and CDT are two important advanced treatment options for these high risk patients. Careful multidisciplinary evaluation and selection maximizes clinical benefit.
Author Disclosures: J.I. Ejiofor: None. G. Piazza: None. A.V. Norman: None. M. Yammine: None. S. McGurk: None. J.M. McCabe: None. S.Z. Goldhaber: None. S.F. Aranki: None. P.S. Shekar: None. P. Sobieszczyk: None. T. Kaneko: None.
- © 2016 by American Heart Association, Inc.