Long-Term Results of Lung Decortication in Patients with Trapped Lung Secondary to Coronary Artery Bypass Grafting

Abstract

Purpose: To evaluate long-term results of decortications in patients with symptomatic restrictive pleurisy and trapped lung after coronary bypass grafting. Methods: Twenty consecutive patients undergoing lung decortications for trapped lung after coronary bypass grafting were prospectively evaluated. Pulmonary function tests were used as objective criteria, and quality of life was assessed by the Medical Research Council dyspnea scale. A p value <0.05 was considered significant. Results: Twenty patients, 3 women and 17 men, with a median age of 59 years were evaluated. The median time interval between coronary bypass grafting and decortications was 9.3 months. The mean preoperative forced expiratory volume in one second and forced vital capacity were 63.8% ± 7.4% and 50.5% ± 6.6% of the predicted value, respectively, and the improvement rates after decortications were 14.97% ± 6.3% and 17.62% ± 6.38%, respectively. Dyspnea scores improved after decortications (p <0.05). The median follow-up was 25 months. After surgery, 3 patients developed superficial wound infections, and out of 7 patients with prolonged air leaks, 2 underwent re-operation. After surgery, one patient died on day 34 and another, after 3 years. Conclusion: Lung decortications, re-expanding the affected lung, ensures symptom remission and improves quality of life of patients with trapped lung after coronary bypass grafting in the long-term. Keywords: lung, decortication, restrictive pleurisy, trapped lung, coronary artery bypass grafting Ann Thorac Cardiovasc Surg 2012; 18: 109-114 doi: 10.5761/atcs.oa.11.01715 by time intervals. Pleural effusions developed within the first week of coronary bypass surgery are mostly small in amount and tend to resolve spontaneously, or can be treated by one or two simple thoracentesis. A few of them may remain persistent, and large effusions developed at a later stage may lead to trapped lung in time, despite all medical or minimally-invasive surgical approaches. If trapped lung (restrictive pleurisy) develops, the treatment of choice is decortication. Although several authors have reported the results of decortications in patients with trapped lung, long-term outcomes remain uncertain.The aim of the present study was to evaluate the longterm results of decortications performed in patients with trapped lung, developed after CABG surgery.

Pleurectomy Decortication in the Treatment of the “Trapped Lung” in Benign and Malignant Pleural Effusions

“…The mean preoperative FEV1 and FVC, which were 63.8% AE 7.4% and 50.5% AE 6.6% of the predicted value, respectively, improved by a rate of 14.97% AE 6.3% and 17.62% AE 6.38%, respectively. 33 …”

Pleural cerebrospinal fluid shunting causing trapped lung: A respiratory physician's approach to management and prevention

“…Additionally, a study by Stefani et al [ 26 ] found that about 70% of patients who had decortication delayed by only 21–30 days had worse outcomes compared to earlier decortication [ 26 ]. This being said, even patients with long-standing trapped lung have been found to have improvement in lung function [ 25 ] and dyspnea [ 28 ] following decortication. Therefore surgical decortication is still recommended regardless of trapped lung chronicity.…”

Management options for the complicated pleural space

“…Lung perfusion and radiographic expansion are also increased after surgical decortication [39,40]. Similarly, decortication for trapped lung after coronary artery bypass grafting results in improvements of FEV 1 by 15.0±6.3 % and VC by 17.6±6.4 % of predicted values [41]. and However, surgical decortication has a mortality risk of 1.3-6.6 % [20].…”