Pneumothorax complicating cardiac surgery

Pneumothorax is an infrequent complication of cardiac surgery. In order to evaluate potential causative or associated factors and to formulate guidelines for prevention and management of this complication, we undertook a retrospective nine-year analysis of our adult cardiac surgical procedures. Twenty-one of 1463 patients suffered a postoperative pneumothorax for an overall incidence of 1.4%. Life threatening pneumothoraces occurred in four patients. Seven of 21 had chronic obstructive pulmonary disease. Eighteen required chest tube insertion. Four patients, including three with chronic obstructive pulmonary disease, required further interventions. These included additional chest tube insertion in three, high constant chest tube suction in three, tetracycline pleurodesis in three, and thoracotomy in one patient. Pneumothoraces following cardiac surgery are often preventable, may be associated with prolonged morbidity, and are potentially life threatening. Conservative management with chest tube drainage is usually successful. Patients with chronic obstructive lung disease are more likely to suffer prolonged morbidity and require thoracotomy.