title: Respiratory System Function in Patients after Aortic Valve Replacement through Right Anterior Minithoracotomy.
abstract: BackgroundThe aim of the study was to analyze respiratory system function after minimally invasive aortic valve replacement through right anterior minithoracotomy (RAT-AVR).MethodsAn observational study of 187 patients electively scheduled for RAT-AVR between January 2010 and December 2013. Pulmonary complications were analyzed and spirometry examinations were performed preoperatively, 1 week, 1 month, and 3 months after surgery.ResultsHospital mortality was 1.1%. A double-lumen intratracheal tube was used in 88.2% and single-lumen intratracheal tube was used in 11.8% of patients. Pulmonary complications occurred in 10.8% of the patients. Prolonged (>24 hours) mechanical ventilation time was present in five patients (2.7%). The reasons were stroke (n= 1), perioperative myocardial infarction (n= 2), and pneumothorax (n= 2). Right pleural effusion, which occurred in 7.7% (n= 14) of patients, was the most frequent respiratory system complication. One week after surgery, the spirometry parameters decreased in comparison to the preoperative period, then after 3 months statistically significant improvement occurred; however, the spirometry parameters still had not returned to preoperative values. Multivariable median regression analysis shows that the presence of chronic obstructive pulmonary disease and pulmonary complications were associated with lower values of forced expiratory volume in 1 second after surgery. There was no statistically significant difference regarding spirometry values or incidence of pulmonary complications after surgery between patients in whom single-lung or double-lung ventilation was applied.ConclusionPulmonary functional status measured with spirometry parameters was diminished after RAT-AVR surgery. Single-lung ventilation did not result in a higher rate of respiratory complications after RAT-AVR surgery.
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital Jagiellonian University, Krakow, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Stoliński
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital Jagiellonian University, Krakow, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Plicner
authors.affiliation: Department of Statistics, Krakow University of Economics, Krakow, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Fijorek
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital Jagiellonian University, Krakow, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Grudzień
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital Jagiellonian University, Krakow, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Kruszec
authors.affiliation: Department of Anesthesiology and Intensive Therapy, John Paul II Hospital Jagiellonian University, Krakow, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Andres
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital Jagiellonian University, Krakow, Poland.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Kapelak
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015505:Chest Tubes; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D004867:Equipment Design; D005260:Female; D005541:Forced Expiratory Volume; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D016014:Linear Models; D008168:Lung / Q000503:physiopathology*; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012121:Respiration, Artificial / Q000295:instrumentation; D012307:Risk Factors; D013147:Spirometry; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome