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The Journal of Cardiovascular Surgery 2021 Nov 26

DOI: 10.23736/S0021-9509.21.12081-6


lingua: Inglese

Initial experience and early outcomes of the management of acute pulmonary embolism using the FlowTriever mechanical thrombectomy device

Alejandro PIZANO , Hunter M. RAY, Tommaso CAMBIAGHI, Naveed U. SAQIB, Rana AFIFI, Sophia KHAN, Gordon MARTIN, Stuart A. HARLIN

Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA


BACKGROUND: Submassive and massive pulmonary embolism is associated with a high risk of complications. We aimed to evaluate our initial experience with a mechanical thrombectomy device in the management of these patients.
METHODS: A single-center, retrospective study was performed in patients with acute submassive and massive pulmonary embolism treated with the FlowTriever device (Inari Medical, Irvine, CA) between June 2019 and November 2020. Clinical and technical parameters were analysed during the hospitalization and at 30- and 180-days after the procedure.
RESULTS: Fourteen patients were evaluated with a median (IQR) age of 60 (50-69) years and 64% were male. All had right heart strain as the main indication for thrombectomy. The procedure duration and fluoroscopic time was 52 (37-89) and 13 (9-24) minutes, respectively. There was 100% technical success, and the pulmonary arterial pressure went from 60 (48-65) mmHg to 40 (34-47) mmHg. Thrombolysis was used in two patients and nine patients required intensive care. 100% experienced improvement in symptoms at the time of discharge. There were no device-related complications, major bleeding events, myocardial infarctions, or deaths. Preprocedural haemoglobin was 13 (12-15) g/dl, and pre-discharge was 12 (10-13) g/dl. Overall post-procedural length of stay was three (2-6) days. All the patients were discharged with oral anticoagulation. There were no devicerelated complications or recurrence of embolism at 30 and 180 days.
CONCLUSIONS: The mechanical thrombectomy device for submassive and massive pulmonary embolism is promising and appears a safe and effective procedure with 100% technical success, no complications, short intensive care requirement/stay, and good early clinical outcomes.

KEY WORDS: Pulmonary embolism; Thrombectomy; Thrombolysis

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