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A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Frequency: Bi-Monthly

ISSN 0021-9509

Online ISSN 1827-191X


The Journal of Cardiovascular Surgery 2002 October;43(5):715-22



Influence of underlying lung disease on early postoperative course after single lung transplantation

Ceriana P. 1, Klersy C. 2, Veronesi R. 3, Braschi A. 3, D’Armini A. 4, Viganò M. 4

1 Res­pir­a­tory Inten­sive ­Care ­Unit, ­IRCCS ''S. Mau­geri'' Foun­da­tion, Med­ical ­Centre of ­Pavia
2 Depart­ment of Clin­ical Epi­dem­i­ology and Biom­etry
3 Depart­ment of ­Anaesthesia and Inten­sive ­Care
4 Depart­ment of Car­diac Sur­gery, IRCCS Pol­i­clinico San ­Matteo, ­Pavia, ­Italy

Back­ground. ­Single ­lung trans­plan­ta­tion can be a suit­able ther­a­peutic ­option for a ­wide ­range of end-­stage ­lung dis­eases: pul­mo­nary ­fibrosis, emphy­sema, pri­mary pul­mo­nary hyper­ten­sion and ­Eisenmenger’s syn­drome. Yet, ­patients suf­fering ­from dif­ferent dis­eases ­have sig­nif­i­cantly dif­ferent car­di­o­vas­cular and res­pir­a­tory func­tional pro­files ­that can ­exert a pro­found influ­ence on ­their ­response to the per­i­op­er­a­tive pro­ce­dures. Our pur­pose is to ana­lyze ­whether the ­patient’s under­lying dis­ease can influ­ence the ­early post­op­er­a­tive out­come ­after ­single ­lung trans­plan­ta­tion.
­Methods. We car­ried out a ret­ro­spec­tive anal­ysis on per­i­op­er­a­tive ­charts of ­patients under­going ­single ­lung trans­plan­ta­tion ­during an ­8-­year ­period. We ­focused our atten­tion on the fol­lowing ­data: under­lying ­lung dis­ease, age, sex, base­line car­di­o­res­pir­a­tory ­data (pul­mo­nary ­artery pres­sure, car­diac ­index, ­forced ­expired ­volume, ­vital ­capacity, arte­rial ­blood ­gases, ­body ­mass ­index), intra­op­er­a­tive ­data (dura­tion of ­graft ­ischemia, use of car­di­o­pul­mo­nary ­bypass) and ­indexes of ­adverse post­op­er­a­tive out­come (in-hos­pital ­death, mechan­ical ven­til­a­tory sup­port >7 ­days). ­Patients ­were gath­ered in 3 ­groups (restric­tive, obstruc­tive and vas­cular) ­according to the ­kind of dis­ease and func­tional ­data and the asso­ci­a­tion ­between dis­ease and out­come was ­assessed by ­means of ­logistic regres­sion anal­ysis. More­over, we eval­u­ated ­whether any of the ­patient’s func­tional param­e­ters ­could be con­sid­ered pre­dic­tive of ­adverse post­op­er­a­tive out­come.
­Results. We ­observed a ­weak asso­ci­a­tion ­between restric­tive dis­ease and ­adverse post­op­er­a­tive out­come ­while, on the ­other ­hand, obstruc­tive and vas­cular ­forms ­showed a ­close asso­ci­a­tion ­with an ­adverse out­come, ­with a bor­der­line sta­tis­tical sig­nif­i­cance. ­Among all the con­sid­ered var­i­ables, ­only intra­op­er­a­tive use of CPB ­turned out to be pre­dic­tive of ­adverse out­come, ­while ­other var­i­ables ­simply indi­cated a ­trend ­towards a ­better out­come.
Con­clu­sions. ­Patients ­with vas­cular and obstruc­tive dis­eases ­have the ­worst post­op­er­a­tive ­course, ­with ­a higher in-hos­pital mor­tality ­rate and ­longer dura­tion of ven­ti­la­tion; in par­tic­ular, the per­i­op­er­a­tive ­course of vas­cular ­patients is ­heavily influ­enced by the intra­op­er­a­tive use of car­di­o­pul­mo­nary ­bypass.

language: English


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