Long-term follow-up of patients undergoing catheter-directed or surgical embolectomy for intermediate to high-risk pulmonary embolism

SESSION TITLE: Novel Insights Into CTEPH Management SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:55 pm - 01:40 pm PURPOSE: For Intermediate to High-Risk Pulmonary Embolism (PE), the use of Catheter-Directed Therapy (CDT) and Surgical Embolectomy (SE) are treatment options, with recommended indications for each treatment. However, in the absence of randomized trials, there is no consensus on the optimal intervention for PE patients requiring advanced therapies. Since CDT is less invasive and requires less time for preparation and a shorter operative time, we hypothesized that the time of day of patient admission with a PE would influence the selection of intervention, especially for cases admitted during weekends or at night. In addition, we evaluated and compared the long-term trans-thoracic echo (TTE) outcomes after CDT or SE. METHODS: We performed a retrospective chart review of 40 consecutive patients with acute PE diagnosed by Chest CT angiography (CTA) admitted between 8/2019-6/2022 that were enrolled in the Pulmonary Embolism Response Team database. We performed a t-test for normally distributed continuous variables and Fischer's test for categorical data. We stratified patients by the follow-up periods into 2 time points: <6 months, and ≥6 months after the intervention. If a patient had multiple TTE results >6 months, we used data from the TTE done later for analysis. RESULTS: 15 patients underwent SE and 25 patients underwent CDT. There was a significantly shorter duration of time from admission to intervention in the SE group compared to the CDT group (12.8±10.7 hours vs 30.4±25.6 hours, p=0.016), The time and day of admission were not associated with whether the patient received SE or CDT. (Figure 1). Figure 2 shows the follow-up transthoracic echocardiogram (TTE) outcomes in the SE group n= 11 patients, and the CDT group, n=12 patients. Mean time to TTE at both <6 months and ≥6 months did not differ between groups. There was no significant difference between SE and CDT groups in terms of right ventricular dilation and dysfunction, pulmonary artery systolic pressure (PASP) on follow-up TTE, left ventricular ejection fraction, and tricuspid regurgitation peak velocity, and TAPSE. Figure 3 shows the pre-and post-intervention PASP and TR peak velocity of each patient. CONCLUSIONS: Our study showed that the SE group had a shorter duration of time to intervention from admission, possibly because patients requiring SE are less stable and require more rapid intervention compared to patients receiving CDT. However, there was no difference in the selection of intervention relating to the time of day patients when were admitted. There were no significant differences in important follow-up TTE measurements between the two groups. CLINICAL IMPLICATIONS: Further studies with a large sample size would be warranted to determine the long-term outcomes in patients undergoing SE or CDT. DISCLOSURES: No relevant relationships by Hafiza Noor Ul Ain Baloch No relevant relationships by Madeline Ehrlich No relevant relationships by Yoshiko Ishisaka No relevant relationships by David Steiger