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OBJECTIVE: Re-expansion pulmonary edema (RPE) may sometimes occur after minimally invasive cardiac surgery (MICS) conducted by single-lung ventilation. However, it has not been widely recognized as one of the serious complications after MICS. The aim of this study is to seek the occurrence rate and risk factors of RPE.
METHODS: The study enrolled 381 consecutive patients who underwent MICS with right mini-thoracotomy from March 2005 to October 2013. We retrospectively compared the data between patients with and without RPE, and evaluated the risk factors.
RESULTS: RPE after MICS was observed in 8 patients (2.1%). In preoperative data, greater percentage of an internal use of steroid or immunosuppressant was found in patients with RPE (25% [2/8] vs 1% [4/373]; P = .0056). In operative data, significantly longer operation and cardiopulmonary bypass (CPB) time were found in patients with RPE (388 ± 80 vs 272 ± 61; P < .0002 and 253 ± 79 vs 158 ± 50; P = .0009). Additionally, significantly greater percentage of second CPB run was observed in patients with RPE (38% [3/8] vs 1.3% [5/373]; P < .0001). In postoperative data, prolonged ICU and postoperative hospital stay were found in patients with RPE (9.5 ± 8.5 vs 1.5 ± 0.9; P < .0001 and 41 ± 21 vs 20 ± 9.8; P = .0003). The overall 30-day mortality was 0.8% (3/381), and 30-day mortality of patients with RPE was 12.5% (1/8). By multivariate analysis, preoperative use of steroid or immunosuppressant, longer CPB time (>181 min) and second CPB run were detected as independent risk factors for RPE after MICS (P = .0014, .0302 and .0410, respectively).
CONCLUSIONS: RPE was one of the serious complications after MICS with right mini-thoracotomy, and preoperative use of immunosuppressant and prolonged use of CPB were identified as risk factors for RPE.