Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation, 147(9). https://doi.org/10.1161/CIR.0000000000001117 Dr. Joshua Goldberg et al
Points
- This study includes data on contemporary surgical embolectomy findings and procedures, including the impacts of cardiac bypass and venoarterial extracorporeal membrane resuscitation, in the context of hemodynamically severe pulmonary embolism.
- Most lung embolism-related fatality is linked to abrupt right ventricular failure, making severe pulmonary embolism the third-most common causation of cardiac morbidity and mortality.
- The use of multifunctional pulmonary embolism rescue teams has lately raised medical awareness of acute pulmonary embolism; however, the fatality of patients with chronic obstructive pulmonary embolism who presented with circulatory impairment remains significant when contemporary guidelines-directed care is applied.
- Surgical procedures are frequently used as a last resort when all other therapies have failed. According to the report, individuals suffering from severe pulmonary embolism may have a better chance of surviving if surgery is considered earlier.
Summary
This scientific statement talks about the surgical treatment of acute pulmonary embolism, especially in people who are at high risk, and explains how the latest research backs up a number of surgical procedures. It also looks at possible flaws in the older research, how they might affect the way things are done now, and important research gaps in this area.
In the past two decades, an increasing body of research has described the application of surgical interventions, such as mechanical circulatory support and surgical embolectomy, in patients experiencing a pulmonary embolism.
Surgical embolectomy has primarily been reserved for individuals with medical limitations to other therapies or when different therapeutic approaches collapse since historical data and practice trends influence currently accepted therapeutic interventions. Many studies show the effectiveness and safety of the surgical care of acute pulmonary embolism, particularly in the hemodynamically impaired group, despite a sample bias towards patients with more severe sickness. In order to better comprehend the function of surgical operations in treating pulmonary embolisms, this paper describes contemporary procedures, approaches, and results of surgical embolectomy and venoarterial extracorporeal membrane pumping. It also makes suggestions for future research.
The American Heart Association’s (AHA) logical claim on pulmonary embolism, which has the support of both the American Association for Thoracic Surgery (AATS) and the Society of Thoracic Surgeons (STS), offers details on current surgical methods, plans, and results as well as recommendations for enhancing understanding of the function of biopsy in controlling pulmonary embolism.
The findings discuss areas where the pulmonary embolism therapy group should take the initiative to comprehend surgical approaches and health experience better. As a result, there is a demand for a more precise meaning of elevated risk embolisms, more clinical studies, databases, measures for treatment effectiveness, and a greater focus on raising knowledge and educating the public.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001117
References Goldberg, J. B., Giri, J., Kobayashi, T., Ruel, M., Mittnacht, A. J. C., Rivera-Lebron, B., DeAnda, A., Moriarty, J. M., MacGillivray, T. E., & on behalf of the American Heart Association Council on Cardiovascular Surgery and Anesthesia; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease. (2023). Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association. Circulation, 147(9). https://doi.org/10.1161/CIR.0000000000001117
