Perioperative cardiovascular pathophysiology in patients undergoing lung resection surgery: a narrative review

Shelley, Ben; Glass, Amy Jocelyn; Keast, Thomas; McErlane, James; Hughes, C.; Lafferty, Brian; Marczin, Nándor; McCall, Philip

doi:10.1016/j.bja.2022.06.035

Cited by 17 publications

(20 citation statements)

References 125 publications

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“…Having now confirmed the existence of the association between wave reflection and RV function, this now paves the way for testing of novel therapeutic strategies aimed at aiding adaptation to the unique perioperative physiology seen in patients undergoing thoracic surgery with a view to preventing cardiovascular complications and improving long-term functional capacity. 42 …”

Section: Discussionmentioning

confidence: 99%

Pulmonary artery wave reflection and right ventricular function after lung resection

Glass¹,

McCall²,

Arthur³

et al. 2023

British Journal of Anaesthesia

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Section: Discussionmentioning

confidence: 99%

Pulmonary artery wave reflection and right ventricular function after lung resection

Glass¹,

McCall²,

Arthur³

et al. 2023

British Journal of Anaesthesia

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“…Independent of age, frailty indicates adverse outcomes after cardiac surgery [ 83 ]. However, systematic investigations into the outcomes of elective lung surgery show that the choice of procedure, i.e., video-assisted thoracic surgery VATS versus thoracotomy, does not impact morbidity, whilst the extent of the performed procedure persists as risk factor in multivariate analysis [ 84 ], findings likely owed to the complex pathophysiology of chest interventions [ 85 ]. While minimally invasive thoracic procedures doubtless carry a much lesser burden for the patients, they do not transform peri-operative morbidity and mortality, as those are driven by patient factors, rather than access choice.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal Parathyroid Cancer

Schulte

Galatà

Talat

2022

Cancers

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Parathyroid cancer (PC) is rare, but its pre-operative recognition is important to choose appropriate access strategies and achieve oncological clearance. This study characterizes features of mediastinal parathyroid cancer (MPC) and explores criteria aiding in the pre-operative recognition of malignancy. We assembled data from 502 patients with mediastinal parathyroid neoplasms (MPNs) from a systematic review of the literature 1968–2020 (n = 467) and our own patient cohort (n = 35). Thirty-two of the 502 MPNs (6.4%) exhibited malignancy. Only 23% of MPC patients underwent oncological surgery. Local persistence and early recurrence at a median delay of 24 months were frequent (45.8%), and associated with a 21.7-fold (95%CI 1.3–351.4; p = 0.03) higher risk of death due to disease. MPCs (n = 30) were significantly larger than cervical PC (n = 330), at 54 ± 36 mm vs. 35 ± 18 mm (χ2 = 20; p < 0.0001), and larger than mediastinal parathyroid adenomas (MPA; n = 226) at 22 ± 15 mm (χ2 = 33; p < 0.01). MPC occurred more commonly in males (60%; p < 0.01), with higher calcium (p < 0.01) and parathyroid hormone (PTH) levels (p < 0.01) than MPA. Mediastinal lesions larger than 3.0 cm and associated with a corrected calcium ≥ 3.0 mM are associated with a more than 100-fold higher odds ratio of being malignant (OR 109.2; 95%CI 1.1–346; p < 0.05). The composite 3 + 3 criterion recognized 74% of all MPC with an accuracy of 83%. Inversely, no MPN presenting with a calcium < 3.0 mM and size < 3.0 cm was malignant. When faced with pHPT in mediastinal location, consideration of the 3 + 3 rule may trigger an oncological team approach based on simple, available criteria.

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“…A review of cardiovascular pathophysiology of patients undergoing lobectomy during perioperative period has shown that intraoperative and postoperative inflammation of the heart muscle, and injury of right ventricular function in patients undergoing thoracotomy are associated with postoperative troponin elevations. 5 Therefore, we infer that the combined use of salbutamol/budesonide may improve myocardial oxygen supply through its anti-inflammatory effect and improved lung ventilation, which may reduce the risk of myocardial oxygen demand and supply mismatch and reduce the release of biomarkers such as postoperative troponin, which may improve early postoperative myocardial injury. An observational study of postoperative myocardial injury in high-risk thoracic surgery found that only smoking and type of surgery were independent risk factors for myocardial injury.…”

Section: Introductionmentioning

confidence: 95%

“… 4 The largest cohort study of cardiovascular events (VISION) in non-cardiac patients (over 40,000 patients) showed the incidence rate of MINS after thoracic surgery was 19.8%. 5 …”

Section: Introductionmentioning

confidence: 99%

“…During one-lung ventilation after thoracotomy (OLV), hypoxic pulmonary vasoconstriction, pulmonary collapse, and intraoperative pulmonary artery clamping will lead to right ventricular dilatation and dysfunction, increase the right ventricular end-diastolic volume, and even cause supraventricular arrhythmia. 5 Increased pulmonary vascular resistance may give rise to acute cardiovascular changes that may trigger excessive myocardial contraction, thereby increasing troponin. 9 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Combined Use of Salbutamol/Budesonide in Thoracic Surgery on Postoperative Myocardial Injury (MINS) – A Prospective Randomized Clinical Trial

Lin¹,

Zhang²,

Huang³

et al. 2023

DDDT

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Purpose This study aims to investigate whether the administration of salbutamol/budesonide reduced the incidence of myocardial injury in thoracic surgery. Methods The randomized controlled trial included 298 patients over 45 and at high-risk for cardiovascular complications after lobectomy. Patients in the experimental group were treated with salbutamol/budesonide after anesthesia induction with fiberoptic bronchoscope. The primary outcome was the incidence rates of myocardial injury, assessed before and three days after the operation. The secondary outcome was respiratory function at each time point during the operation, including lung compliance and arterial partial pressure of oxygen, postoperative pulmonary and cardiovascular complications, hospital stay, pain score, and analgesic dosage. Results In the control group, the incidence of myocardial injury was 57/150 (38%), while that in the experimental group was 33/148 (22%); compared between the two groups, the difference in the incidence of myocardial injury was statistically significant. The dynamic compliance and static compliance at half an hour after the start of surgery in the experimental group were significantly improved. Before leaving the operating room, the difference in arterial oxygen partial pressure between the two groups was statistically significant. Conclusion Intraoperative administration of salbutamol/budesonide reduced the incidence of myocardial injury after thoracic surgery, improved lung function, and reduced the incidence of postoperative pulmonary complications.

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Perioperative cardiovascular pathophysiology in patients undergoing lung resection surgery: a narrative review

Cited by 17 publications

References 125 publications

Pulmonary artery wave reflection and right ventricular function after lung resection

Pulmonary artery wave reflection and right ventricular function after lung resection

Mediastinal Parathyroid Cancer

Effects of Combined Use of Salbutamol/Budesonide in Thoracic Surgery on Postoperative Myocardial Injury (MINS) – A Prospective Randomized Clinical Trial

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