Beyond Median Sternotomy: Minimally Invasive Approaches in Surgical Pulmonary Embolectomy - narrative review
DOI:
https://doi.org/10.12775/JEHS.2026.94.72844Keywords
pulmonary embolectomy, minimally invasive, mini-sternotomy, thoracotomy, surgical treatment of pulmonary embolismAbstract
Background
Pulmonary embolism still remains one of the most life-threatening conditions in cardiovascular medicine and remains the third leading cause of death in the United States. Current guidelines recommend surgical treatment of pulmonary embolism in high-risk patients. This procedure is typically performed through a median sternotomy approach with initiation of a cardiopulmonary bypass machine. Patients referred to surgery are often critically ill and burdened with multiple comorbidities that might be a contraindication to conventional surgery.
Aim
This narrative review screened the available literature on minimally invasive surgical approaches in pulmonary embolectomy and evaluated its potential benefits and limitations.
Material and Methods
A targeted literature search was performed using PubMed and Google Scholar databases, supplemented by manual screening of references from relevant articles to identify further eligible studies. Abstracts and full texts were screened, resulting in 8 articles included: 1 research paper, 3 case series, and 4 case reports with a total of 22 patients.
Results
Reported use of minimally invasive approaches in the surgical treatment of pulmonary embolism was described. Across the 22 included patients 1 patient was managed with thoracotomy and 10 patients with a minithoracotomy approach with utilization of various surgical strategies such as: video-thoracoscopic-assistance, or balloon-catheter-assistance. Ministernotomy approach was utilized in 11 patients: 10 patients underwent upper-hemisternotomy with central cannulation, and one patient underwent a right J-ministernotomy.
Conclusions
Median sternotomy remains the gold standard for surgical pulmonary embolectomy, however reported cases of procedures performed using minimally invasive approaches suggest that these techniques may be safe and effective in selected patients with contraindications to conventional approach.
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Copyright (c) 2026 Tomasz Jędrasek, Adrian Korman, Ada Świątko, Wojciech Baran, Patrycja Bartkiewicz, Ewelina Lachowska, Mateusz Chmiela
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