Immediate results of surgical treatment of high and intermediate risk pulmonary embolism in elderly and senile patients

The aim of the study: is to analyze the immediate results of surgical treatment of high-and intermediate-risk PE in a group of elderly and senile patients. Material and methods. The study included 43 patients operated on for high-and intermediate-risk pulmonary embolism between 2008 and 2019. In the general group of patients, the number of women prevailed and amounted to 67.4%. The average age was 65.4 ± 4.23 years old. The Miller index in the general group was 29.1 ± 1.42. The Geneva Index was 8.4 ± 1.12. The average pressure in the pulmonary artery at the time of operation was 54 ± 1.4 mm Hg, and the peak pressure was 68 ± 3.43 mm Hg. Results. 5 patients died at the hospital stage. Thus, the hospital survival rate of patients was 88.4%. Among nonlethal complications, cardiovascular and respiratory failure prevailed. According to the statement, the calculated pressure gradient in the pulmonary artery was 29.0 ± 3.1 mm Hg. Conclusion. Surgical treatment is a highly eff ective and reliable method of treatment in the group of older patients.

1. Claeys M.J., Vandekerckhove Y., Cosyns B., Van de Borne P., Lancellotti P. Summary of 2019 ESC Guidelines on chronic coronary syndromes, acute pulmonary embolism, supraventricular tachycardia and dislipidaemias. Acta Cardiol. 2020; Jan 10:1–8. [Epubahead of print]. PMID: 31920149. DOI: 10.1080/00015385.2019.1699282

2. Iaccarino A., Frati G., Schirone L., Saade W., Iovine E., D’Abramo M., De Bellis A., Sciarretta S., & Greco E. Surgical embolectomy for acute massive pulmonary embolism: state of the art. J.Thoracic Dis. 2018;8(1):5154–5161. DOI: 10.21037/jtd.2018.07.87

3. Yamamoto T. Management of patients with high-risk pulmonary embolism: a narrative review. J. Intensive Care. 2018;16(6). DOI: 10.1186/s40560-018-0286-8

4. Goldhaber S.Z. Venous Thromboembolism in Heart Failure Patients: Pathophysiology, Predictability, Prevention. Am. Coll. Cardiol. 2020;75(2):159–162. PMID: 31948644. DOI: 10.1016/j. jacc.2019.11.028

5. Medvedev A.P., Fedorov S.A., Trofimov N.A., Tselousova L.M. Errors in the diagnosis and treatment of pulmonary embolism. Kardiologiya i serdechno-sosudistaya khirurgiya. 2021;14(1):54–59. (in Russian). DOI: 10.17116/kardio202114011546

6. Medvedev A.P., Fedorov S.A. Successful surgical treatment of massive pulmonary embolism with simultaneous mitral valve replacement. Grudnaya i serdechno-sosudistaya khirurgiya. 2018;60(3):254–260. (in Russian). DOI: 10.24022 / 0236-2791-2018-60-3-254-260

7. Engelberger R.P. Kucher N. Reperfusion Treatment for Acute Pulmonary Embolism. Hamostaseologie. 2018;8(2):98–105. DOI: 10.1055/s-0038-1641717

8. Becattini C. Agnelli G. Risk stratifi cation and management of acute pulmonary embolism. Hematology Am. Soc. Hematol. Educ. Program. 2016;2(1):404–412. DOI: 10.1182/asheducation-2016.1.404

9. Mongan J., Kline J., Smith-Bindman R.Age and sex-dependent trends in pulmonary embolism testing and derivation of a clinical decision rule for young patients. Emergency Med. J. 2015;32(11):840– 845. DOI: 10.1136/emermed-2014-204531

10. Khoury H., Lyons R., Sanaiha Y., Rudasill S., Shemin R.J., Benharash P. Deep venous thrombosis and pulmonary embolism in cardiac surgical patients. Ann. Thorac. Surg. 2020;109(6):1804–1810. DOI: 10.1016/j.athoracsur.2019.09.055

11. Trofimov N.A., Medvedev A.P., Nikol’skij A.V., Kichigin V.A., Zhamlihanova S.S., Babokin V.E. Denervation of the pulmonary arteries in patients with mitral valve defects complicated by atrial fi brillation and high pulmonary hypertension. Sovremennye tekhnologii v medicine. 2019;11(4):95–105. (in Russian)

12. Babokin V., Trofimov N. Prevention of atrial fi brillation recurrence after the Maze IV procedure. Ann. Thorac Surg. 2020;109:1624– 1625.

13. Trofi mov N.A., Medvedev A.P., Babokin V.E., Dragunov A.G., Kichigin V.A., Nikol’skiĭ A.V., Zhamlihanova S.S. Effect of circular sympathetic denervation of the pulmonary arteries on the degree of pulmonary hypertension in patients with mitral valve pathology and atrial fi brillation. Klin. i eksperiment. hir. Zhurn. im. akad. B.V. Petrovskogo. 2019;7(4):32–41. (in Russian). DOI: 10.24411/2308-1198-2019-14004