Prevention of Pulmonary Edema after Minimally Invasive Cardiac Surgery with Mini-Thoracotomy Using Neutrophil Elastase Inhibitor

Yamashiro, Satoshi; Arakaki, Ryoko; Kise, Yuya; Kuniyoshi, Yukio

doi:10.5761/atcs.oa.17-00102

Cited by 9 publications

(5 citation statements)

References 22 publications

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“…The incidence varies from study to study. The reported incidence of radiographically evident UPE after MICS was 5.0%-7.9%, and that of symptomatic UPE after MICS was reported to be 1.5% or "rare" [1,2]. As the number of MICS procedures has increased, reports related to UPE after MICS have increased as well.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Pulmonary Edema after Minimally Invasive Cardiac Surgery: A Case Report

2022

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Unilateral pulmonary edema after minimally invasive cardiac surgery is a rare, but potentially life-threatening condition. However, the exact causes of unilateral pulmonary edema remain unclear. We experienced aggressive unilateral pulmonary edema followed by redo-resection of recurrent left atrial myxoma through a right mini-thoracotomy. Intraoperative veno-venous extracorporeal membrane oxygenation was applied after the termination of cardiopulmonary bypass, and separate mechanical ventilation using a double-lumen endotracheal tube was applied after surgery. The patient was successfully treated and discharged uneventfully.

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Section: Discussionmentioning

confidence: 99%

Unilateral Pulmonary Edema after Minimally Invasive Cardiac Surgery: A Case Report

2022

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“…A number of inflammatory factors are involved in the damage to the lungs and other important organs after CPB [ 22 , 23 ]. Evidence shows that neutrophils are closely related to the degree of lung injury and the levels of inflammatory factors [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine Improves Lung Function by Promoting Inflammation Resolution in Patients Undergoing Totally Thoracoscopic Cardiac Surgery

Cui

Gao

Huang

et al. 2020

Oxidative Medicine and Cellular Longevity

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Objective. Totally thoracoscopic cardiac surgery under cardiopulmonary bypass combined with one-lung ventilation has been identified as the trend in cardiac surgery. The aim of this study was to examine the effects of the selective α2 adrenergic receptor agonist dexmedetomidine on the pulmonary function of patients who underwent mitral valve surgery using the totally thoracoscopic technique. Methods. Fifty-seven patients who underwent thoracoscopic mitral valve surgery between July 2019 and December 2019 were selected. The patients were randomly divided into the control (Con) group (n=28) and the dexmedetomidine (DEX) group (n=29) using the random number table method. Arterial blood gas analyses were performed, and the oxygenation (PaO2/FiO2) and respiratory indexes (P(A-a)O/PaO2) were calculated 5 min after tracheal intubation (T1), 2 h after operation (T2), 6 h after operation (T3), and 24 h after operation (T4). Moreover, the serum cytokines interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule-1 (ICAM-1) were detected using the enzyme-linked immunosorbent method at all time points. Chest radiography was performed 24 h after surgery. Peripheral blood samples were collected before and after the operation for a complete hemogram. Additionally, the procalcitonin concentration was measured and recorded when the patients were transported to the intensive care unit (ICU). The postoperative extubation time, length of ICU stay, and pulmonary infection rate were also recorded. Results. Inflammatory reaction after surgery was evident. However, the inflammatory cytokines IL-6, TNF-α, and ICAM-1 in the DEX group were lower than those in the Con group after surgery (T2 to T4; P<0.05). Neutrophil counts and procalcitonin concentration were higher in the Con group than in the DEX group (P<0.05). In addition, in the DEX group, pulmonary exudation on chest radiography was lower, and pulmonary function, as shown by an increase in oxidation index and decrease in the respiratory index, improved after surgery (P<0.05). Moreover, the duration of mechanical ventilation in the Con group was 3.4 h longer than that in the DEX group. Conclusion. Dexmedetomidine has a protective effect on pulmonary function in patients undergoing mitral valve surgery using a totally video-assisted thoracoscopic technique, which may be related to a reduction in the concentration of inflammatory cytokines in the early perioperative period.

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“…17) Recently, sivelestat was also reported to exert protective effects against re-expansion pulmonary edema, which is one of the crucial complications that occurs after minimal invasive cardiac surgery with minithoracotomy. 18) Most clinical studies have demonstrated that sivelestat attenuates lung injury or improves pulmonary dysfunction; however, Toyama et al showed that it improves not only the respiratory index but also changes in the fractional area of the left ventricle during pediatric cardiovascular surgery with cardiopulmonary bypass. 17) Consistently, the present study demonstrated an improvement in both LV function and endothelial function after cardioplegic arrest when sivelestat was administered during the first 10 min of reperfusion in isolated Langendorff-perfused rat hearts.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil Elastase Inhibitor Sivelestat Attenuates Myocardial Injury after Cardioplegic Arrest in Rat Hearts

Fujii

Bessho

2019

ATCS

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Purpose: Sivelestat, a neutrophil elastase inhibitor, attenuates global ischemia-induced myocardial damage and coronary endothelial dysfunction. Here, we investigated whether sivelestat exerts the cardioprotective effects against cardioplegic arrest in rat hearts. Methods: Isolated Langendorff-perfused rat hearts were randomly allocated to three groups and subjected to 2-min infusions with St. Thomas' Hospital cardioplegic solution No. 2 (STH2) and 30-min global ischemia followed by 60-min reperfusion as follows: (i) control (STH2 treatment only), (ii) sivelestat (19 μmol/L) infusion for the first 10 min of reperfusion, and (iii) sivelestat (19 μmol/L) infusion for 10 min before ischemia and for the first 10 min of reperfusion. Left ventricular developed pressure (LVDP) recovery and troponin T leakage were measured at the end of reperfusion. Coronary flow response to acetylcholine (ACh) was assessed. Results: Single and multiple doses of sivelestat significantly improved LVDP recovery (69 ± 15 and 69 ± 14 vs 48 ± 15 [control]; p <0.05) and decreased troponin T leakage (0.4 ± 0.3 and 0.7 ± 0.5 vs 1.7 ± 0.6 [control]; p <0.05). Multiple doses of sivelestat significantly improved coronary flow response to ACh (121 ± 9 vs 105 ± 4; p <0.05). Conclusions: Addition of sivelestat to STH2 attenuates myocardial injury after cardioplegic arrest in rat hearts. This cardioprotective effect was achieved even when sivelestat was administered during early reperfusion.

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Prevention of Pulmonary Edema after Minimally Invasive Cardiac Surgery with Mini-Thoracotomy Using Neutrophil Elastase Inhibitor

Abstract: Purpose: Unilateral re-expansion pulmonary edema (RPE) is a rare but one of the most critical complications that may occur after re-expansion of a collapsed lung after minimally invasive cardiac surgery (MICS) with mini-thoracotomy.

Cited by 9 publications

References 22 publications

Unilateral Pulmonary Edema after Minimally Invasive Cardiac Surgery: A Case Report

Unilateral Pulmonary Edema after Minimally Invasive Cardiac Surgery: A Case Report

Dexmedetomidine Improves Lung Function by Promoting Inflammation Resolution in Patients Undergoing Totally Thoracoscopic Cardiac Surgery

Neutrophil Elastase Inhibitor Sivelestat Attenuates Myocardial Injury after Cardioplegic Arrest in Rat Hearts

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