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THE JOURNAL OF CARDIOVASCULAR SURGERY

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

lingua: Inglese

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


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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.

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