Introduction:
Since publication of our initial experience with non-sternotomy
minimally invasive pulmonary embolectomy (MIPE) via a left mini
thoracotomy, we have expanded our experience, refined the operation and
streamlined the post-operative management of patients.
Our initial publication described three patients who underwent
MIPE.1 We described our technique which included
peripheral cardiopulmonary bypass (CPB) via femoral arterial and venous
cannulation, left sided 5cm anterior thoracotomy in the
3rd intercostal space, identification and incision of
the main pulmonary artery distal to the pulmonic valve, extraction of
clot with subsequent primary closure of the pulmonary artery, and use of
a 5mm, 30 degree laparoscope as an adjunct to assess clearance of the
pulmonary artery.2 The patients included in this
series had no post-operative complications, had a mean hospital length
of stay of three days with mid-term follow-up up to 8-months revealing
no untoward complications of the procedure.
With early success of the MIPE at our institution, we began employing it
preferentially over sternotomy with central CPB and pulmonary
embolectomy. Since initial publication of our results, we have performed
the MIPE in two additional patients with excellent outcomes. We herein
present augmentations we’ve made to the procedure with a
case-presentation which highlights these adaptations.