Preventive Strategy for Reexpansion Pulmonary Edema After Minimally Invasive Cardiac Surgery

Reexpansion pulmonary edema is a serious complication of minimally invasive cardiac surgery through the right minithoracotomy. As reexpansion mechanical injury and ischemia reperfusion injury to the collapsed lung are possible mechanisms, we introduced a preventive protocol that consists of intermittent ventilation of the right lung, restoration of bilateral ventilation, administration of mannitol before unclamping the aorta, and institution of mild hypothermia. Among 469 patients who underwent minimally invasive cardiac surgery, we used this protocol in 379 patients. Reexpansion pulmonary edema incidence decreased significantly from 7.8% to 2.1% (P = .006). Although further evaluation is required, our protocol may be effective in preventing reexpansion pulmonary edema.