What is Pulmonary Artery Embolectomy with or without Cardiopulmonary Bypass: Overview, Benefits, and Expected Results

Definition & Overview

Pulmonary artery embolectomy is a medical procedure that removes an embolus from the inside of the pulmonary artery. An embolus (plural, emboli) refers to any particle inside the arteries or veins. Clinical examinations show that most emboli, if not all, are composed of clotted blood cells.

Some emboli may not cause serious harm and even symptoms. In fact, some can dissolve on their own. However, if they accumulate over time, they can pose a serious health threat because they can potentially obstruct the blood vessel cavity. Blocked blood vessels can eventually rupture, which can lead to internal bleeding.

The pulmonary artery is one of the only two arteries (the other is the umbilical artery) in the body that carries deoxygenated blood from the heart to the lungs.

In some cases, the presence of an embolus in the pulmonary artery can be a major health issue and can cause high mortality rate despite of the many advancements in embolectomy. The reason being is that emboli can break away and rupture at one point during the operation and travel to other blood vessels. When this happens, there is a possibility that they will get trapped in one area, creating a major blockage in the process. Often, this blockage happens in the brain and can cause serious health hazards and sometimes, even death.

In some cases, a procedure called thrombolysis (a process of dissolving blood clot with a drug that acts like an enzyme), can be useful. However, the downside is that many patients who were administered with such drug often experience internal bleeding.

For patients with anatomically extensive pulmonary embolism, or large deposits of emboli in the pulmonary artery, they almost always experience haemorrhage within the skull (intracranial haemorrhage) when administered with a thrombolytic drug. For this reason, surgical methods are often considered for the treatment of the condition.

Pulmonary artery embolectomy can be performed with or without cardiopulmonary bypass, a medical technique where the function of the heart and lungs is temporarily taken over by a machine, called CPB pump, because the organs are unable to perform their normal function during the operation.

Surgeons decide whether to use or not to use cardiopulmonary bypass following a thorough assessment of the patient’s condition and unique circumstances. Although the procedure can, in many cases, improve the chances of a successful operation, it can also lead to postsurgical complications.

Who Should Undergo and Expected Results?

Pulmonary artery embolectomy with or without cardiopulmonary bypass is often indicated for patients suffering from aggressive pulmonary embolism. These patients typically present with symptoms that are very similar to other conditions including pneumonia, heart attack, and asthma. For this reason, there have been cases where patients were misdiagnosed. These symptoms include:

• Sudden, sharp chest pain
• Sudden shortness of breath
• Rapid heart rate
• Coughing up foamy mucus or blood
• Anxiety
• Fainting

Based on statistics, up to 89% of pulmonary artery embolectomy patients survive the procedure. However, some patients suffer from serious complications, including death, as early as a month after surgery. Despite that, pulmonary artery embolectomy is still used to extend the life of patients nearing death due to their dysfunctional haemodynamic profile.

Haemodynamics refers to the flow of blood to the organs and tissues of the body.

How is the Procedure Performed?

Pulmonary artery embolectomy is performed through a procedure called median sternotomy, which is performed by making a vertical incision along the sternum (breastbone). Doing so separates or divides the breastbone and allows surgeons to access the heart. The procedure requires general anaesthesia.

A transverse arteriotomy (cutting or opening the arterial wall) is then performed to remove emboli around the pulmonary artery. The identified clots can be removed all at the same time using simple gallbladder stone forceps. In some cases, venous drainage using a vacuum is also used.

To prevent recurrences, filters are put in place in the inferior vena cava immediately after the operation before the breastbone is sutured and closed.

Patients are placed under intensive care for a day or two right after the procedure for close monitoring. Any breathlessness, nagging or intolerable pain in the chest, and discharge at the incision area should be reported to the surgeon immediately.

Possible Risks and Complications

Postoperative clinical data shows that some patients developed hypotension (abnormally low blood pressure) and hypoxemia (abnormally low concentration of oxygen in the blood) during and after surgery. Some also develop tamponade (abnormal pressure around the heart) due to the accumulation of excess fluid in and around the pericardial cavity. The development of tamponade is very common with patients suffering from cancer or those who have gone through minimally to highly invasive surgical procedures on the heart and lungs. Infections can also happen and are treated with antibiotics.

Patients also face the risks associated with any type of open surgery including adverse allergic reactions to anaesthesia and blood loss.

Other risks include arrhythmias, cholesterol embolism, ruptured blood vessels, and damage to surrounding organs and tissues.


References:

• US National Library of Medicine National Institutes of Health; “Aggressive Approach to Pulmonary Embolectomy for Massive Acute Pulmonary Embolism: A Historical and Contemporary Perspective”; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931612/

• Ahajournals; “Acute Pulmonary Embolectomy: A Contemporary Approach”; http://circ.ahajournals.org/content/105/12/1416

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## Introduction



Pulmonary artery embolectomy is a ​surgical procedure commonly used to remove blood clots from the pulmonary‍ arteries. This procedure can be⁤ performed with or without cardiopulmonary bypass, depending on the patient’s⁤ condition. In this article, we will provide an overview of pulmonary⁢ artery embolectomy, discuss the benefits of both methods, and explain what‍ patients can expect from this procedure. So, let’s dive in!



## What is Pulmonary‌ Artery Embolectomy?



Pulmonary artery embolectomy is a surgical procedure specifically designed to remove blood clots,‍ also known as emboli, from the pulmonary arteries. These emboli can be life-threatening and can cause sudden blockages, leading to serious⁤ complications such as pulmonary embolism⁤ or even⁣ death.



The procedure⁤ involves making an incision in the patient’s chest to gain access to the pulmonary artery. The‌ blood clot is then carefully ​removed or ​fragmented using specialized instruments, allowing the blood flow to⁤ be restored in the affected area.



## Pulmonary Artery⁣ Embolectomy with Cardiopulmonary Bypass



In some ⁤cases, pulmonary artery embolectomy may be performed with the assistance‌ of cardiopulmonary bypass (CPB). During this ⁤method, the patient’s‌ blood is ‌rerouted through a heart-lung machine, which takes over the function of the heart⁢ and lungs ⁣temporarily. This allows⁢ the surgeon to perform the procedure in a bloodless field, making ⁣it⁢ easier‍ to visualize ‍and remove the blood clot.



Benefits ‌of Pulmonary Artery Embolectomy with Cardiopulmonary Bypass:



1. Improved ⁢Visualization: The ⁢use of cardiopulmonary bypass provides a bloodless field, allowing the surgeon ⁤to⁤ have better visibility⁢ during the procedure. This can aid in the ⁢precise removal of blood clots and minimize the risk of complications.



2. Reduced ‌Stress on the Heart and Lungs: ‌By temporarily taking over the function of the heart and lungs, cardiopulmonary bypass reduces the physical stress placed ⁣on these organs during the surgical procedure. This can be particularly ​beneficial for ⁣patients with pre-existing heart or lung conditions.



## Pulmonary Artery ⁣Embolectomy without Cardiopulmonary Bypass



In some cases, pulmonary ⁣artery embolectomy can be performed without‌ the use of cardiopulmonary bypass.‍ This approach is ⁤typically reserved for patients who‍ are​ hemodynamically stable, meaning their blood flow and pressure are within a ‌normal range.



Benefits ‍of Pulmonary Artery Embolectomy without Cardiopulmonary‌ Bypass:



1. Reduced Risk of Complications: By avoiding the use of ⁤cardiopulmonary bypass, the risk of complications associated with⁢ the bypass machine, such as bleeding or infection, is minimized.



2. Shorter Operation Time: Performing the procedure ‍without cardiopulmonary bypass can lead to shorter ⁢operating times, reducing ‌the overall ‍surgical ⁢stress on the patient.



## Expected Results and Recovery



After undergoing pulmonary​ artery embolectomy, patients can ⁤expect a⁤ gradual improvement in their symptoms. The procedure aims to restore blood flow​ to‍ the lungs, relieving the symptoms associated with pulmonary artery blockage.



The recovery process will⁤ vary depending on‍ the patient’s overall ⁢health and the severity of the ‍blood‍ clot. In general, patients‍ can anticipate spending a few days in the hospital for ‍close monitoring ‌and recovery. Pain medications and ‍blood thinning‌ medications may be prescribed to manage pain and prevent further clot formation.



It⁣ is important for patients⁣ to⁢ follow their healthcare provider’s instructions regarding activity restrictions, wound care,‍ and medication management. Regular follow-up appointments will be scheduled​ to monitor the patient’s progress and ensure proper healing.



## Conclusion



Pulmonary artery embolectomy is a lifesaving procedure that aims ⁣to remove blood clots from the pulmonary arteries. It can​ be ‍performed with or without ⁤cardiopulmonary bypass, depending on the patient’s condition and surgical team’s⁢ preference. Both methods have their own set of benefits, allowing surgeons to tailor the approach to the individual patient.



Patients who‌ undergo this⁢ procedure can expect an improvement in their symptoms and a gradual return to normal ⁣activities. The recovery⁢ process will differ for each patient, and it ‌is crucial to follow the‍ healthcare provider’s instructions for optimal healing.



Overall,⁤ pulmonary artery embolectomy is an effective treatment option for individuals suffering‌ from ‍pulmonary embolism. If you or a loved one is facing this condition, consult a healthcare professional to determine the most appropriate treatment approach for your ⁤specific situation.