Symptomatic Persistent Post-Coronary Artery Bypass Graft Pleural Effusions Requiring Operative Treatment

Lee, Gary; Vaz, Marcelo A.C.; Ely, Kim; McDonald, Edward C.; Thompson, Philip J.; Nesbitt, Jonathan C.; Light, Richard W.

doi:10.1378/chest.119.3.795

Cited by 60 publications

(36 citation statements)

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“…When severe, pleural fibrosis (PF) can cause restrictive lung disease and fibrothorax that occur with respiratory impairment and morbidity. Along these lines, PF can result from pneumonia with complicated parapneumonic pleural effusions, empyema, trauma, malignant pleural effusions that loculate, or asbestos-related pleural injury and occur in some patients that have undergone coronary artery bypass graft surgery (12,21). PF also contributes to increased mortality of patients with comorbidities including cardiac disease (4,7).…”

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confidence: 99%

Mesomesenchymal transition of pleural mesothelial cells is PI3K and NF-κB dependent

Owens

Jeffers

Boren

et al. 2015

American Journal of Physiology-Lung Cellular and Molecular Phys

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Pleural organization follows acute injury and is characterized by pleural fibrosis, which may involve the visceral and parietal pleural surfaces. This process affects patients with complicated parapneumonic pleural effusions, empyema, and other pleural diseases prone to pleural fibrosis and loculation. Pleural mesothelial cells (PMCs) undergo a process called mesothelial mesenchymal transition (MesoMT), by which PMCs acquire a profibrotic phenotype characterized by cellular enlargement and elongation, increased expression of α-smooth muscle actin (α-SMA), and matrix proteins including collagen-1. Although MesoMT contributes to pleural fibrosis and lung restriction in mice with carbon black/bleomycin-induced pleural injury and procoagulants and fibrinolytic proteases strongly induce MesoMT in vitro, the mechanism by which this transition occurs remains unclear. We found that thrombin and plasmin potently induce MesoMT in vitro as does TGF-β. Furthermore, these mediators of MesoMT activate phosphatidylinositol-3-kinase (PI3K)/Akt and NF-κB signaling pathways. Inhibition of PI3K/Akt signaling prevented TGF-β-, thrombin-, and plasmin-mediated induction of the MesoMT phenotype exhibited by primary human PMCs. Similar effects were demonstrated through blockade of the NF-κB signaling cascade using two distinctly different NF-κB inhibitors, SN50 and Bay-11 7085. Conversely, expression of constitutively active Akt-induced mesenchymal transition in human PMCs whereas the process was blocked by PX866 and AKT8. Furthermore, thrombin-mediated MesoMT is dependent on PAR-1 expression, which is linked to PI3K/Akt signaling downstream. These are the first studies to demonstrate that PI3K/Akt and/or NF-κB signaling is critical for induction of MesoMT.

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confidence: 99%

Mesomesenchymal transition of pleural mesothelial cells is PI3K and NF-κB dependent

Owens

Jeffers

Boren

et al. 2015

American Journal of Physiology-Lung Cellular and Molecular Phys

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“…Pleurodesis is rarely achieved because of the non-expanding lung. 10,12) In our series, pleurodesis has not been performed in any of the patients because of the presence of trapped lung. Huggins et al 13) in their study in 2007 reported that a high index of suspicion was a key to diagnosis, and rather than repetitive unnecessary tests, pleural manometry and air-contrast CT should enable rapid diagnosis.…”

Section: Discussionmentioning

confidence: 91%

“…8,9) Operative intervention is necessary for these patients. 2,10,11) Trapped lung occurs when a fibro-elastic peel is formed over the visceral pleura on part or all of a lung lobe. This fibrotic peel can prevent the expansion of the underlying lung (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The timing of decortication after CABG is unclear; however, Lee and colleagues 10) reported eight patients with persistent pleural effusions who required surgical intervention after 2 years of follow-up after CABG surgery. As trapped lung represents an end-stage fibrotic process, many authors suggest that the development of trapped lung usually requires several months to years after the pleural injury 10,11,14) However, in order to decide about the surgical correction of the pleuropulmonary process, that had developed after a coronary bypass, there should be a waiting period with certain medical or minimal invasive surgical treatments.…”

Section: Discussionmentioning

confidence: 99%

“…As trapped lung represents an end-stage fibrotic process, many authors suggest that the development of trapped lung usually requires several months to years after the pleural injury 10,11,14) However, in order to decide about the surgical correction of the pleuropulmonary process, that had developed after a coronary bypass, there should be a waiting period with certain medical or minimal invasive surgical treatments. In our patients, the median waiting period for surgery was 9.3 months.…”

Section: Discussionmentioning

confidence: 99%

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

Çelık

Çelik

Aydemir

et al. 2012

ATCS

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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.

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Pleural Disease

Light¹

2005

Evidence‐based Respiratory Medicine

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Symptomatic Persistent Post-Coronary Artery Bypass Graft Pleural Effusions Requiring Operative Treatment

Cited by 60 publications

References 11 publications

Mesomesenchymal transition of pleural mesothelial cells is PI3K and NF-κB dependent

Mesomesenchymal transition of pleural mesothelial cells is PI3K and NF-κB dependent

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

Pleural Disease

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