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Retrograde pulmonary embolectomy performed without aortic cross-clamping and closed left-sided heart chambers

MOJ Surgery
Ivayla Zheleva,1 Ass Prof Dimitar Kyuchukov2

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Despite recent diagnostic and surgical management advances in massive pulmonary embolism (PE) treatment, the prognosis of patients is still unfavorable. The current surgical technique is direct antegrade embolectomy using cardiopulmonary bypass and beating heart, without cardioplegic arrest and hypothermia. A significant disadvantage of this approach is the inability to evacuate distally located thrombotic substances. Several authors offer a solution to these problems by applying retrograde pulmonary perfusion or retrograde pulmonary embolectomy. In 2017 Hussain provided a simplified method for performing retrograde perfusion without left atriotomy. In 2019, we served emergency procedures similar to Hussain’s in two patients with massive PE. As an adjunct, we did them on normothermia beating heart and without aortic clamping.


surgical pulmonary embolectomy, retrograde pulmonary perfusion, beating heart