Delayed chest closure after lung transplantation: Techniques, outcomes, and strategies
Delayed chest closure after lung transplantation: Techniques, outcomes, and strategies
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DOI：
10.1016/j.healun.2014.03.003
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发表时间：
2014-07-01
影响因子：
8.9
通讯作者：
Bermudez, Christian A.
中科院分区：
文献类型：
--
作者：
Shigemura, Norihisa;Orhan, Yucel;Bermudez, Christian A.
背景：对于体外循环时间延长、缺血时间延长、凝血障碍或供体肺移植物过大的病例，肺移植后延迟闭胸（DCC）是一种可行的选择。由于DCC对肺移植术后预后的影响尚未完全阐明，因此手术室内DCC的决策对外科医生来说仍然具有挑战性。方法：我们对90例肺移植合并DCC和783例原发性闭胸患者进行回顾性分析，以阐明DCC的原因、DCC的并发症和不良结局的危险因素。结果：DCC组30天和90天死亡率分别为7.8%和9.9%。DCC组术后早期出血及严重原发性移植物功能障碍（PGD）发生率较高（p < 0.05）。在多因素分析中，延长体外循环使用时间（bbbb4小时）、术后体外需氧量和使用开放皮肤和收缩肋骨的DCC技术与死亡率显著相关（p < 0.05），而延长DCC时间与死亡率无显著相关性。在一项匹配的队列研究中，将DCC技术与皮肤闭合的结果与类似匹配的对照组进行比较，DCC显著降低了严重PGD的发生率（9.6% vs 26%, p < 0.05），与初次闭合相比，移植后生存率和功能状态得到改善。结论：本文描述了我们预防DCC病例可能出现的问题的技术方法。DCC可以在可接受的程序相关风险下安全地进行。DCC不应被认为是肺移植后的次优选择。(C) 2014年国际心肺移植学会。版权所有。
BACKGROUND: Delayed chest closure (DCC) after lung transplantation is a viable option to be taken in the cases of prolonged cardiopulmonary bypass time, prolonged ischemic time, coagulopathic problems or oversized donor lung grafts. Decision-making for DCC in the operating room remains challenging to surgeons, because the impact of DCC on outcomes after lung transplantation has not yet been fully elucidated.METHODS: We performed a retrospective review of 90 lung transplantations with DCC and 783 cases with primary chest closure to clarify the reasons for DCC, complications of DCC, and the risk factors for adverse outcomes.RESULTS: The 30- and 90-day mortality in the DCC group was 7.8% and 9.9%, respectively. Early post-operative bleeding and severe primary graft dysfunction (PGD) were higher in the DCC group (p < 0.05). In multivariate analysis, prolonged cardiopulmonary bypass use (> 4 hours), post-operative extracorporeal oxygen requirement and use of a DCC technique with open skin and retracted ribs were significantly associated with mortality (p < 0.05), whereas prolonged duration of DCC was not. In a matched cohort study to compare the results of a DCC technique with skin closure to similarly matched controls with primary closure, DCC contributed to significantly decreased incidence of severe PGD (9.6% vs 26%, p < 0.05), leading to an improved post-transplant survival and functional status as compared with primary closure.CONCLUSIONS: Our technical approaches to prevent possible problems in DCC cases are described. DCC can be safely performed with acceptable procedure-related risks. DCC should not be considered a sub-optimal option after lung transplantation. (C) 2014 International Society for Heart and Lung Transplantation. All rights reserved.