Long‐term outcome of nitinol stenting to treat asphyxia caused by postpneumonectomy syndrome

Abe, Jiro; Hasumi, Toru; Tanaka, Ryota; Saito, Yasuki; Kanma, Keishi; Takahashi, Satoshi

doi:10.1002/rcr2.207

Cited by 3 publications

(5 citation statements)

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“…of patients) Revision (Y/N) (no. of patients) OCEBM score Harney et al [ 12 ] 1 Metallic stent 49 y LRTI 30 mo Good Y: re-stenting 4 Moser et al [ 14 ] 1 Silastic stent 12 y Good 5 mo Died: alcohol intoxication and aspiration N 4 Abe et al [ 17 ] 1 2 metallic stents 3 y Good 12 y Recurrent LRTIs. Died—respiratory failure N 4 Nakamura et al [ 13 ] 1 Balloon dilation 10 y Poor; stent inserted 3 mo Died–MI N 4 Cordova et al [ 30 ] 1 2 metallic stents 4 y Good 1 y Good N 4 Stratakos et al [ 38 ] 1 Metallic stent 2 y Poor 6 mo Died–PE Y: silastic stent insertion 4 ...…”

Section: Resultsmentioning

confidence: 99%

“…This was treated with Radiesse ® voice gel injection, without satisfactory subjective improvement [ 35 ]. Overall outcomes following repositioning without prostheses were poor, requiring an additional procedure in all cases [ 16 , 17 ].…”

Section: Resultsmentioning

confidence: 99%

“…Bronchial stenting with a silastic stent alone has been described with good results in one patient, despite insufficient follow-up [ 24 ]. Overall mortality in this patient cohort is 66.7%, with one patient dying of respiratory failure 12 years post-nitinol stent insertion following recurrent hospitalisations with LRTIs [ 17 ]. Stenting would be inappropriate in branching, distorted bronchi due to difficulty in stent placement and poor stent epithelialisation [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options

Christodoulides

Fitzmaurice

Bukowska

et al. 2023

J Cardiothorac Surg

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Objectives Post-pneumonectomy syndrome (PPS) is rare and predominantly characterised by dynamic airway obstruction due to mediastinal rotation at any time point following pneumonectomy. The objective of this systematic review was to identify the optimal treatment strategy for PPS based on subjective symptomatic relief, objective radiological imaging, and treatment durability. Methods A systematic review was performed up to and including February 2022 based on the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” guidelines. All studies that presented the management of symptomatic patients > 16 years of age with radiologically confirmed PPS were included. The primary outcome was the identification of the optimal treatment strategy and the secondary outcome was durability of the treatment. The Oxford Centre for Evidence Based Medicine level was assigned to each study. Results A total of 330 papers were identified and reviewed; 41 studies met the inclusion criteria. Data including patient demographics, indication for initial pneumonectomy, presenting symptoms, management approach, outcomes, and follow-up were assessed and analysed. Management approaches were divided into three categories: (a) mediastinal repositioning using implant prostheses; (b) endobronchial stenting; (c) other corrective procedures. One hundred and four patients were identified in total and of those, 87 underwent mediastinal repositioning with insertion of a prosthetic implant. Complications included over- or under-filling of the prosthesis (8.5%) and implant leakage (8.9%). Conclusion Management of PPS using a prosthetic implant to reposition the mediastinum is the treatment of choice. Key adjuncts to optimise surgical approach and minimise complications include pre-operative CT volumetric analysis to guide implant size and intra-operative transoesophageal echocardiography to guide mediastinal repositioning.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options

Christodoulides

Fitzmaurice

Bukowska

et al. 2023

J Cardiothorac Surg

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“…One is repositioning of the mediastinum via surgery and filling of the postpneumonectomy space with a non-absorbable material (3)(4)(5). Another option is endobronchial intervention (6,7). However, the treatments must be prepared before the development of PPS.…”

Section: Discussionmentioning

confidence: 99%

“…That is, the position of the shifted mediastinum can be treated with surgery, intrapleural gas injection therapy, or intrathoracic tissue expander (3)(4)(5). Another option is the placement of expandable stents at the compressed portion of the airway (6,7).…”

Section: Introductionmentioning

confidence: 99%

Postpneumonectomy syndrome related to the thickness of the fat tissue in the anterior mediastinum: a retrospective observational study

2020

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Background: Postpneumonectomy syndrome (PPS) is a life-threatening condition characterized by the extrinsic compression of the mainstem bronchus after pneumonectomy, causing rapidly progressive dyspnea.Information regarding the predictive factors of this condition is limited. Thus, the current study aimed to identify the predictive findings that can help prepare the treatment of PPS in advance.Methods: The present study is a retrospective observational study. We reviewed the medical records of 12 consecutive patients who underwent pneumonectomy for lung cancer or tuberculosis between 2009 and 2020. The anatomical findings evaluated via computed tomography scan, nutritional status assessed using laboratory data, respiratory function, intraoperative variables between PPS and non-postpneumonectomysyndrome patients were compared. Results: There were two female patients who presented with left PPS (PPS 1 and PPS 2 aged 73 and 55 years, respectively). The median age of 10 non-postpneumonectomy-syndrome patients (n=6, men and n=4 women) was 66 (range, 54-76 years). Four and six patients underwent right and left pneumonectomy, respectively. The fat tissue thickness in the anterior mediastinum was significantly thinner in PPS than in non-postpneumonectomy-syndrome patients. However, the body mass index (BMI) and other nutritional parameters did not differ between PPS and non-postpneumonectomy-syndrome patients. The median vital capacity was higher in PPS than in non-postpneumonectomy-syndrome patients. The decrement of respiratory function and body weight after pneumonectomy did not differ between two groups. The intraoperative variables did not also differ between two groups. Conclusions: The fat tissue in the anterior mediastinum between the bilateral lungs is an anchor that can help maintain the normal position of the mediastinum after pneumonectomy. Thus, the fat tissue thickness between the bilateral lungs can be a predictive factor for the occurrence of PPS before surgery.

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Treatment of postpneumonectomy syndrome with silicone breast implant and chimeric latissimus dorsi and serratus anterior muscle flaps

Gencel,

Avci,

Kokaçya

et al. 2024

Cukurova Medical Journal

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We report treatment of postpneumonectomy syndrome in a 11 years old boy by silicone breast implant and latissimus dorsi and serratus muscle flaps. The patient was admitted for with severe dyspnea and cough at the postoperative 5th month of pneumonectomy operation for congenital cystic adenomatoid malformation. Tomographic and bronchoscopic examinations revealed right mediastinal shift. Fibrotic tissue between heart and right pneumonectomy site was dissected, main bronchus was released and medialized. Dead space was filled with silicone breast implant. Latissimus dorsi and serratus anterior muscle flaps were used to cover and also to create a barrier between implant and major vessels.

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Long‐term outcome of nitinol stenting to treat asphyxia caused by postpneumonectomy syndrome

Cited by 3 publications

References 4 publications

Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options

Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options

Postpneumonectomy syndrome related to the thickness of the fat tissue in the anterior mediastinum: a retrospective observational study

Treatment of postpneumonectomy syndrome with silicone breast implant and chimeric latissimus dorsi and serratus anterior muscle flaps

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