title: Unilateral pulmonary oedema after minimally invasive cardiac surgery via right anterolateral minithoracotomy.
abstract: OBJECTIVE
  To investigate the incidence of unilateral pulmonary oedema after minimally invasive cardiac surgery (MICS) requiring unilateral lung collapse has been unknown until now.
  
  
  METHODS
  We analysed the data of 484 consecutive patients undergoing minimally invasive cardiac surgery with unilateral lung collapse between January 2008 and December 2013. The clinical regimen was changed in 2010 to a single dose of dexamethasone (approximately 1 mg/kg body weight) administered after anaesthesia induction.
  
  
  RESULTS
  Thirty-eight patients developed a radiographically evident unilateral pulmonary oedema within 24 h after surgery. Dexamethasone significantly reduced the incidence of this event [4.0 vs 12.9%; unadjusted odds ratio (OR) 0.28, 95% confidence interval (CI) 0.14-0.58, P < 0.001]. One patient with and six patients without dexamethasone were clinically symptomatic (P = 0.001). Logistic regression analysis identified four variables significantly associated with the development of a unilateral lung oedema: dexamethasone (OR 0.28, 95% CI 0.13-0.58, P = 0.001), diabetes mellitus (OR 3.17, 95% CI 1.04-9.63, P = 0.04), the level of mean pulmonary arterial pressure (OR 1.05 per mmHg, 95% CI 1.004-1.09, P = 0.03) and transfusion of fresh frozen plasma (OR 2.31, 95% CI 1.02-5.25, P = 0.045).
  
  
  CONCLUSIONS
  Our data revealed a 7.9% incidence of radiographically evident unilateral pulmonary oedema after MICS with intraoperative collapse of a lung. Of the total number of patients, 1.5% simultaneously developed clinical symptoms. The influence of corticosteroids, as well as the contribution of possible risk factors, needs further evaluation.
authors.affiliation: Department of Anesthesiology, Heart Center Freiburg University, Bad Krozingen, Germany cornelius.keyl@universitaets-herzzentrum.de.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Keyl
authors.affiliation: Department of Anesthesiology, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Staier
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Clarence
authors.initials: C
authors.lastname: Pingpoh
authors.affiliation: Section of Cardiovascular Radiology, Department of Radiology, Center for Diagnostic and Therapeutic Radiology, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Pache
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Thoma
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Günkel
authors.affiliation: Section of Cardiovascular Radiology, Department of Radiology, Center for Diagnostic and Therapeutic Radiology, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Henschke
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D008943:Mitral Valve / Q000601:surgery; D011654:Pulmonary Edema / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013908:Thoracotomy / Q000009:adverse effects*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Corticosteroids; Minimally invasive cardiac surgery; Mitral valve; Pulmonary oedema