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Unilateral postoperative pulmonary edema after minimally invasive cardiac surgical procedures: a case-control study
Mark P Tutschka1, Daniel Bainbridge2, Michael W A Chu3
1Program in Critical Care, Department of Medicine, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada.
Background:
Unilateral postoperative pulmonary edema is an underreported adverse event after a minimally invasive cardiac surgical procedure that combines right minithoracotomy with cardiopulmonary bypass. We sought to characterize its incidence, risk factors, and morbidity.
Methods:
We conducted a retrospective case-control study of all cardiac surgical procedures that combined right-sided minithoracotomy with cardiopulmonary bypass at our institution over 8 consecutive years. Unilateral postoperative pulmonary edema was defined on the chest radiograph taken on the first postoperative day as relatively increased opacification of the right versus left hemithorax involving at least 20% of the hemithorax, not better explained by atelectasis. Baseline characteristics, potential risk factors, and outcomes were subject to univariable and multivariable analysis.
Results:
Radiographs were available for 277 of 278 patients; of those, 68 (25%) met our definition of unilateral postoperative pulmonary edema. Patients with unilateral postoperative pulmonary edema had higher mortality and were more likely to have a lower postoperative PaO2/FIO2 ratio, to require vasoactive medications and mechanical ventilation for longer than 24 hours, and to have longer lengths of stay in the intensive care unit and the hospital. Unilateral postoperative pulmonary edema was independently associated with chronic obstructive pulmonary disease (odds ratio [OR] 4.79; 95% confidence interval [CI] 1.28 to 18.0; p = 0.02); pulmonary hypertension, right-ventricular dysfunction, or both (OR 2.92; 95% CI 1.41 to 6.03; p = 0.004); and increasing cardiopulmonary bypass time (OR 1.019; 95% CI 1.011 to 1.027 per additional minute; p <0.001).
Conclusions:
Unilateral postoperative pulmonary edema after minimally invasive cardiac surgical procedures is common, carries significant morbidity, and has identifiable risk factors. Further research is needed to enable a better understanding of the pathophysiology and clinical implications of unilateral postoperative pulmonary edema.
Insights
Unilateral postoperative pulmonary edema after minimally invasive cardiac surgery is common, affecting 25% of patients. Risk factors include COPD, pulmonary hypertension, and longer cardiopulmonary bypass times, leading to increased morbidity and mortality.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Unilateral postoperative pulmonary edema (UPE) is an underreported complication following minimally invasive cardiac surgery (MICS) using right minithoracotomy and cardiopulmonary bypass.
- Characterizing the incidence, risk factors, and associated morbidity of UPE is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence and identify risk factors for UPE after MICS.
- To assess the morbidity associated with UPE in this patient population.
Main Methods:
- Retrospective case-control study of patients undergoing MICS with right minithoracotomy and cardiopulmonary bypass over 8 years.
- UPE defined by chest radiograph findings (right vs. left hemithorax opacification >20%).
- Univariable and multivariable analyses of baseline characteristics, risk factors, and outcomes.
Main Results:
- 68 of 277 patients (25%) developed UPE.
- UPE associated with higher mortality, lower PaO2/FIO2 ratio, prolonged mechanical ventilation, and longer ICU/hospital stays.
- Independent risk factors for UPE included COPD, pulmonary hypertension/right-ventricular dysfunction, and increased cardiopulmonary bypass time.
Conclusions:
- UPE is a common complication after MICS, associated with significant morbidity.
- Identifiable risk factors suggest potential for targeted prevention strategies.
- Further research is warranted to elucidate pathophysiology and clinical implications.
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