Scientific statement suggests more consideration for surgery in high-risk patients with PE
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Evidence suggests that high-risk patients with pulmonary embolism can benefit from surgical management, according to a scientific statement issued by the American Heart Association.
“This statement demonstrates that modern surgical management strategies and mechanical circulatory support results in excellent survival (97%) even among the sickest patients, including those who present with cardiac arrest and have had CPR,” Joshua B. Goldberg, MD, chair of the statement writing group, an attending cardiothoracic surgeon, surgical director of the Westchester Transcatheter Heart Valve Program and director of Cardiac Surgery Outcomes Research at the Westchester Heart and Vascular Center in Valhalla, New York, said in a press release.
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“Modern surgical strategies and mechanical circulatory support are drastically underutilized,” Goldberg, who presented the statement at the Society of Thoracic Surgeons Annual Meeting, said in the release. “It is the hope of the multidisciplinary group of authors that this scientific statement will provide a greater awareness of the safety and efficacy of modern surgical management and mechanical circulatory support in treating the most unstable patients so that lives may be saved. In addition, we hope this statement will facilitate improved understanding of the disease process and effective treatments and encourage future research to improve the survival of patients with this common and deadly disease.”
The statement is endorsed by the STS and the American Association for Thoracic Surgery and its value has been affirmed by the Society for Cardiovascular Angiography and Interventions.
Traditionally, surgical embolectomy and mechanical circulatory support have been considered salvage therapies for high-risk patients with PE, but modern surgical embolectomy and veno-arterial extracorporeal membrane oxygenation “demonstrate favorable safety and efficacy profiles when we account for the baseline level of illness of the populations in whom they are used,” Goldberg and colleagues wrote in the scientific statement, published in Circulation. “Expansion of the use of surgical embolectomy and mechanical circulatory support may provide additional survival benefit in a population in whom the current treatment paradigms continue to be associated with exceedingly high mortality.”
The writing group called for high-risk and fulminant patients to be included in current and future PE registries, and for high-risk PE to be redefined.
“To better risk-stratify patients, compare treatment modalities, and risk-adjust outcomes, more precise strata reflecting patients’ hemodynamic and clinical status are necessary to separate the population with salvage/fulminant PE from the high-risk population,” Goldberg and colleagues wrote.
In addition, the statement called for increased education to encourage use of surgical strategies earlier in treatment for PE.
References:
- Goldberg JB, et al. Circulation. 2023;doi:10.1161/CIR.0000000000001117.
- New statement suggests more patients may benefit from surgery for pulmonary embolism. newsroom.heart.org/news/new-statement-suggests-more-patients-may-benefit-from-surgery-for-pulmonary-embolism. Published Jan. 23, 2023. Accessed Jan. 23, 2023.
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Goldberg JB, et al. Adult Cardiac Late Breaker. Presented at: Society of Thoracic Surgeons Annual Meeting; Jan. 21-23, 2023; San Diego.
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