Background: Heart-lung transplant (HLT) is indicated in select children with end-stage cardiopulmonary disease. We sought to determine whether previous thoracic surgery increases peri-operative morbidity and mortality.
Methods: Retrospective data were analyzed using unpaired Student's t-test and Fisher's exact test. Results are reported as mean +/- SD. Peri-operative mortality was defined as death at =30 days post-transplant.
Results: From August 1993 through April 2001, 13 patients (mean age 7.9 +/- 5.3 years; 9 girls, 4 boys) underwent HLT at our center. Eight of 13 (62%) had previous thoracic surgery and 5 of 13 (38%) did not. Interval of last surgery to transplant date was 45.5 +/- 26.4 months (range 6 to 79 months). We compared HLT patients who had previous thoracic surgery to HLT recipients who did not. There was no significant difference in weight (18.6 +/- 14.3 vs 36.5 +/- 20.7 kg, p = 0.09), age (6.5 +/- 4.5 vs 10.2 +/- 6.1 years, p = 0.23) or duration of intubation (14.1 +/- 12.9 vs 17.0 +/- 30.3 days, p = 0.83). There were no caval or tracheal anastomotic stenoses in either group. There was no significant difference in blood products transfused =48 hours after HLT: packed red blood cells (p = 0.16); fresh frozen plasma (p = 0.13); platelets (p = 0.59), and cryoprecipitate (p = 0.27). There was no difference in cardiopulmonary bypass time (129.3 +/- 48.2 vs 160.6 +/- 73.9 minutes, p 0.39); post-operative diaphragm dysfunction (4 of 8 vs 0 of 5, p = 0.1); re-exploration for bleeding (2 of 8 vs 1 of 5, p = 1.0); or peri-operative mortality (2 of 8 vs 0 of 5, p = 0.48).
Conclusions: We conclude that previous thoracic surgery in HLT recipients does not significantly increase blood product transfusion, cardiopulmonary bypass time or peri-operative mortality.
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http://dx.doi.org/10.1016/j.healun.2003.08.035 | DOI Listing |
Chiropr Man Therap
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Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
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Statistical Sciences, Eli Lilly and Company, Shanghai, China.
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Thoracic Surgery, Fukuyama City Hospital, Fukuyama, JPN.
Descending necrotizing mediastinitis (DNM) is a severe, life-threatening infection that requires prompt diagnosis and aggressive surgical intervention. Management is particularly challenging when the condition is complicated by bilateral empyema and perivascular involvement. A 73-year-old woman presented with septic shock several days after experiencing pharyngeal pain.
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Student Research Unit, School of Medicine, 21 September University, Sana'a, YEM.
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Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN.
A 41-year-old man with a history of obesity, hypertension, and smoking suffered from numbness and weakness in both lower limbs. He was diagnosed with ossification of the posterior longitudinal ligament and ligamentum flavum in the cervical and thoracic spine by X-rays, CT, and MRI. The patient underwent laminectomies at T2 and T3 levels, along with posterior fusion from T1 to T4, to address an upper thoracic spine lesion causing sensory deficits up to T5 and gait disturbances.
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