Multi Center Experience With Pulmonary Mechanical Thrombectomy
Mitchell George, MD, Samuel Leonard, MD, Charles Miller, PhD, Gregory Estrera, Shihuan Wang, MD, Stuart Harlin, MD.
UT Houston, Houston, TX, USA.
OBJECTIVES: Mechanical pulmonary thrombectomy (MPT) is an emerging treatment for acute pulmonary embolus (PE). Indications currently are for intermediate high risk PE, which is defined by evidence of right heart strain on imaging and laboratory signs of right heart strain such as elevated brain natriuretic peptide (BNP) or troponin. The goal of this study is to present physiologic data and outcomes for MPT.
METHODS: This study was a retrospective chart review of all instances of MPT within eleven different hospitals within the Memorial Hermann Health System from December 2019 through August 2021, using the Inari FlowTriever system. We report patient demographics, clinical presentation, intraoperative metrics, and outcomes. RESULTS: 77 patients underwent MPT in the designated time period. Average patient age was 61 years with 42% of patients being male and average BMI 35.5. 5% of patients had coronary artery disease, 6% had congestive heart failure, 16% had history of DVT and 10% had history of PE. and 16% were current smokers. 58% of patients treated with MPT were classified as intermediate high risk, while 30% were intermediate low risk, 4% low risk, and 6% were high risk. Average intra-op pulmonary arterial pressure was 33.5 mmHg which dropped to 23.3 mmHg after treatment. Average blood loss was 179 mL with average hemoglobin drop from admission to discharge 2 g/dL with 7 patients (9%) requiring post-procedure blood transfusions. There was one post procedure death, and one post op myocardial infarction. Average overall length of stay was 5.6 days for all patients. 20 patients required ICU admission with 2 day average ICU length of stay. CONCLUSIONS: MPT is a safe and effective approach for acute pulmonary embolism evidenced by its low mortality and improvement in intra-procedural pulmonary arterial pressure. This study is limited by lack of long term follow up. Randomized control trials are needed to prove the efficacy of MPT over other treatments such as catheter directed thrombolysis.
|Low risk PE||4%|
|Intermediate Low Risk PE||30%|
|Intermediate High Risk PE||58%|
|Pre-Procedure PA pressure||33.5 mmHg|
|Post Procedure PA Pressure||23.3 mmHg|
|Post op Blood Transfusion||9%|
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