Surgical treatment of acute pulmonary embolism: a modified surgical technique to avoid deep hypothermia and circulatory arrest

Massive acute pulmonary embolism (MAPE) is a rare and life-threatening condition that the cardiothoracic surgeon could face during its clinical practice. Since the great improvement in pharmacological and interventional treatment, MAPE is usually non-surgically treated. A surgical approach, even if it has proved to be a good and highly performing alternative to the thrombolysis, is considered only after a failure of the medical therapy or in presence of massive occlusion of the main branches of the pulmonary arteries. In order to achieve a good and blood-less view of the operative field, some cardiothoracic surgeons usually prefer to treat this condition adopting the same technique used for the chronic pulmonary embolism recurring to deep hypothermia and circulatory arrest. This approach usually leads to neurologic or splanchnic hypoperfusion problems therefore we will describe a modified surgical technique that don’t require deep hypothermia or circulatory arrest and thank to which it is not only possible to reduce surgical lengths but also to speed up postoperative recovery in the intensive care unit (ICU). Shorter cardiopulmonary bypass times, indeed, means lower haemodilution and decreased inflammatory response therefore it leads to a decreased risk of cerebral, lung and renal edema and a faster ICU discharge.