Deep venous thrombosis and pulmonary thromboembolism remain major sources of patient morbidity and mortality. The authors present the case of a 55-year-old man with a massive pulmonary embolism and subsequent hemodynamic decompensation who was successfully treated by open pulmonary embolectomy supported with cardiopulmonary bypass. Indications for embolectomy and patient selection as well as technical considerations are discussed.