Background: Pulmonary embolectomy remains the only option for patients with
fulminant pulmonary embolism and failure or contraindication of thrombolys
is even today. Increasing prevalence of heparin-induced thrombocytopenia ty
pe II (HIT) adds a new significant problem, which was investigated in a ret
rospective study. Methods: Between 1/1979 and 1/1998 41 patients (21 male;
age: 51.1 +/- 14.8 years) with fulminant pulmonary embolism underwent pulmo
nary embolectomy under cardiopulmonary bypass: group I (1979 - 89): 31 pati
ents; group II (1990-98): 10 patients. Group II included only patients who
did not meet the criteria for acute thrombolysis, in 4 patients a HIT was p
reoperatively assured. All patients were in strongly compromised hemodynami
c condition (33/41 high-dose catecholamines, 24/41 mechanical ventilation,
14/41 preoperative cardiopulmonary resuscitation). Results: Perioperative m
ortality was 29% (group I: 9/31; group II: 3/10; n.s.) Preoperative resusci
tation was the only predictive factor (with resuscitation: 9/14; without re
suscitation: 3/27; p<0.001). Severe but not fatal complications occurred in
11 patients: they fully recovered following treatment. Follow-up was compl
eted to 93% (281 patient-years; mean: 10.6 years) and discovered 5 late dea
ths (late mortality: 1.7%/patient-year; 1 patient: bleeding due to anticoag
ulation; 4 patients: not related to operation). 26/28 (93%) patients were i
n NYHA functional class I or II. No recurrent pulmonary embolism or late cl
inical symptoms related to embolectomy were observed. There was no differen
ce between group I and group II (including the 4 patients with HIT) regardi
ng perioperative mortality, complication, and late results. Conclusions: Pu
lmonary embolectomy on cardiopulmonary bypass remains an adequate therapy i
n patients with failure of or contraindication to thrombolysis, and HIT is
not a contraindication.