title: Re-expansion pulmonary oedema after minimally invasive cardiac surgery with right mini-thoracotomy.
abstract: OBJECTIVE
  Re-expansion pulmonary oedema (RPO) sometimes occurs after minimally invasive cardiac surgery (MICS) with single-lung ventilation. However, it has not been widely recognized as a serious complication. The aim of this study is to evaluate the occurrence rate and risk factors of RPO.
  
  
  METHODS
  A total of 381 consecutive patients who underwent MICS with right mini-thoracotomy from March 2005 to October 2013 were retrospectively reviewed.
  
  
  RESULTS
  RPO was observed in 8 (2.1%) patients. In the preoperative data, greater percentages of preoperative use of steroid or immunosuppressant were found in patients with RPO (25% [2/8] vs 1% [4/373]; P = 0.0056). In the operative data, significantly longer operation, cardiopulmonary bypass (CPB) and aortic cross-clamping (ACC) times as well as greater percentages of second CPB run were found in patients with RPO (388 ± 80 vs 272 ± 61 min; P < 0.0002, 253 ± 79 vs 158 ± 50 min; P = 0.0009, 162 ± 65 vs 108 ± 38 min; P = 0.020 and 38% [3/8] vs 1.3% [5/373]; P < 0.0003). The overall 30-day mortality rate was 0.8% (3/381) and the 30-day mortality rate of patients with RPO was 12.5% (1/8). Significantly prolonged initial ventilation time, intensive care unit and postoperative hospital stay were observed in patients with RPO (P = 0.0022, <0.0001 and 0.0003, respectively). Multivariate logistic analysis detected preoperative use of steroid or immunosuppressant and prolonged ACC time (≥156 min) as independent risk factors for RPO after MICS (odds ratio [OR]: 87.6 [95% confidence interval, CI: 4.1-2463.8]; P = 0.006 and OR: 36.0 [95% CI: 4.8-731.4]; P < 0.001).
  
  
  CONCLUSIONS
  RPO should be recognized as one of the most serious complications after MICS with right mini-thoracotomy. More accurate risk factors of prolonged lung malperfusion and steroid use on RPO after MICS should be investigated.
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Irisawa
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan bassbord1028@yahoo.co.jp.
authors.forename: Arudo
authors.initials: A
authors.lastname: Hiraoka
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Totsugawa
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Genta
authors.initials: G
authors.lastname: Chikazawa
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Nakajima
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tamura
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yoshitaka
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011654:Pulmonary Edema / Q000209:etiology* / Q000401:mortality; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013906:Thoracoscopy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D014057:Tomography, X-Ray Computed
keywords: Cardiopulmonary bypass; Minimally invasive cardiac surgery; Re-expansion pulmonary oedema; Valve surgery