Novel Treatment of an Acute High-Risk Pulmonary Embolism: Surgical Pulmonary Embolectomy Via Ministernotomy with Awake Percutaneous Cardiopulmonary Bypass
J. Goldberg Westchester Medical Center, White Plains, New York
Cardiothoracic Surgeon Weill Cornell Medicine/New York Presbyterian Hospital New York, New York, United States
Disclosure(s):
Joshua Goldberg, MD: No financial relationships to disclose
Please explain the educational or technical point that this video addresses.: Surgical pulmonary embolectomies are typically performed in the setting of hemodynamic instability and acute, severe RV dysfunction. As a result, cardiac arrest is often associated with anesthesia induction and intubation. This video describes a strategy which avoids hemodynamic instability and cardiac arrest with anesthesia induction by placing the patient on cardiopulmonary bypass prior to anesthesia induction via percutaneous femoral cannulation. The stability that this strategy provides enables the surgeon then to perform the procedure through a ministernotomy. In addition, the surgical steps for a through bilateral embolectomy is described.
Please provide a 250 word summary of the surgical video being submitted.: This video demonstrates a cardiopulmonary bypass cannulation strategy that is performed prior to the induction of general anesthesia which improves the safety of the procedure. This is then followed by bilateral pulmonary artery exposure through a ministernotomy. Next , pulmonary artery brach vessel exposer and embolectomy are described. Lastly, a controlled strategy to decannulate a patient on percutaneous cardiopulmonary bypass is demonstrated.
Learning Objectives:
Upon completion, participant will be able to understand a strategy for safe and effective management of unstable patients with acute pulmonary embolisms.
Upon completion, participant will be able to understand an effective surgical strategy to perform thorough bilateral pulmonary embolectomies.
Upon completion, participant will be able to understand a safe strategy to decannulate patients on percutaneous bypass with percutaneous vascular closure devices.
