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Carugati M, Arif S, Sudan DL, Collins BH, Haney JC, Schroder JN, Reynolds JM, Lewis Stamps S, Yarrington ME, Miller RA, Alexander BD. Late surgical site infections among solid organ transplant recipients: an unrecognized clinical entity. Infect Control Hosp Epidemiol 2024:1-5. [PMID: 38785166 DOI: 10.1017/ice.2024.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
This study identified 26 late invasive primary surgical site infection (IP-SSI) within 4-12 months of transplantation among 2073 SOT recipients at Duke University Hospital over the period 2015-2019. Thoracic organ transplants accounted for 25 late IP-SSI. Surveillance for late IP-SSI should be maintained for at least one year following transplant.
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Affiliation(s)
- Manuela Carugati
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, USA
| | - Sana Arif
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, USA
| | - Debra Lynn Sudan
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, USA
| | - Bradley Henry Collins
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, USA
| | - John Carroll Haney
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, USA
| | - Jacob Niall Schroder
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, USA
| | | | - Sarah Lewis Stamps
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, USA
| | - Michael E Yarrington
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, USA
| | - Rachel A Miller
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, USA
| | - Barbara D Alexander
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, USA
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Carugati M, Arif S, Sudan DL, Collins BH, Haney JC, Schroder JN, Reynolds JM, Lewis SS, Yarrington ME, Miller RA, Alexander BD. Epidemiology of surgical site infections after solid organ transplants in the period 2015-2019: A single-center retrospective cohort study. Am J Transplant 2022; 22:3021-3030. [PMID: 36056456 DOI: 10.1111/ajt.17189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
Surgical site infections (SSI) are severe complications of solid organ transplant (SOT). This retrospective study assessed the epidemiology of and outcomes associated with invasive primary SSI (IP-SSI) occurring within 3 months of transplantation in adult SOT recipients at Duke University over a 5-year period (2015-2019). Among 2073 consecutive SOT recipients, 198 IP-SSI were identified. The IP-SSI rate declined over the period (14.4% in 2015 vs. 8.3% in 2019) and was higher among multi-organ compared with single-organ transplants (33.9% vs. 8.1%, p < .01). SOT recipients with IP-SSI had longer hospital stays than patients without SSI (30.0 vs. 17.0 days, p < .01). Transplant hospitalization (9.6% vs. 2.2%, p < .01), 6-month (11.6% vs. 3.3%, p < .01), and 1-year mortality (15.7% vs. 5.8%, p < .01) were higher in SOT recipients with IP-SSI than in those without. While Gram-positive bacteria were the most common pathogens, urogenital Mollicute and atypical Mycobacteria were identified as an unexpected cause of IP-SSI, particularly among lung transplant recipients. The median time to IP-SSI was 24.0 (IQR 13.8-48.3) days, although the time to IP-SSI varied based on organ transplanted and the causative pathogen. IP-SSI is an important and potentially modifiable complication of SOT, associated with prolonged hospitalizations and reduced survival, particularly in the lung transplant population.
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Affiliation(s)
- Manuela Carugati
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Sana Arif
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Debra Lynn Sudan
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - Bradley Henry Collins
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - John Carroll Haney
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina, USA
| | - Jacob Niall Schroder
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina, USA
| | - John Michael Reynolds
- Department of Medicine, Transplant Pulmonology, Duke University, Durham, North Carolina, USA
| | - Sarah Stamps Lewis
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | | | - Rachel Ann Miller
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Barbara Dudley Alexander
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
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Qian W, Sun W, Xie S. Risk factors of wound infection after lung transplantation: a narrative review. J Thorac Dis 2022; 14:2268-2275. [PMID: 35813752 PMCID: PMC9264078 DOI: 10.21037/jtd-22-543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/01/2022] [Indexed: 12/01/2022]
Abstract
Background and Objective The incidence of incision infection after lung transplantation is prominently high which affect the prognosis. Summarizing the risk factors related to incision infection after lung transplantation contribute to the control of incision infection by pre-controlling the risk factors. The objective is to summarize risk factors related to wound infection after lung transplantation. Methods PubMed was used to research the literature relating to the risk factors to incision infection after lung transplantation through 1990 to 2022. The retrieval strategy were Medical Subject Heading (MeSH) terms combined entry terms. Two researchers conducted the literature retrieval independently. Two researchers independently evaluate the quality of the literature and summarize the indicators. Key Content and Findings A total of 98 researches were collected from PubMed and 8 articles described the related risk factors of incision infection after lung transplantation. All of the 8 articles were retrospective studies, of which 4 articles were grouped by the delayed chest closure (DCC) execution and the other 4 articles were grouped by the surgical site infection (SSI) occurred. Two articles performed multivariate regression analysis to determine the independent risk factors of SSI after lung transplantation and the other 6 articles compared the SSI rate in different patients population. The integrated results showed that bronchoalveolar lavages (BALs), smoking status, body mass index (BMI), diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation. Conclusions BALs, smoking status, BMI, diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation.
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Affiliation(s)
- Weiwei Qian
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Sun
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Shenglong Xie
- Department of Thoracic Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
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Chen C, Zheng Q, Wu D, Song Y, Xu G. Review of outcomes of delayed chest closure following lung transplantation: a meta-analysis. J Cardiothorac Surg 2022; 17:122. [PMID: 35590331 PMCID: PMC9118833 DOI: 10.1186/s13019-022-01868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/29/2022] [Indexed: 02/08/2023] Open
Abstract
Purpose The clinical outcomes of delayed chest closure (DCC) compared with primary chest closure (PCC) following lung transplantation, including perioperative outcomes and long-term survival, remained controversial. This was the first systematic review and meta-analysis aimed to identify the short- and long-term outcomes of DCC following lung transplantation. Methods We comprehensively searched electronic literature from 4 databases up to April 1st, 2022. Dichotomous data and continuous data were pooled with odds ratio and weighted mean difference, respectively. The quality of included studies was assessed with the Newcastle–Ottawa Scale. Results Ten studies were included in the systematic review and 4 studies were included in the meta-analysis. Pooled analysis showed that DCC was associated with an increased risk of surgical site infection, prolonged hospital stays, and higher risk of primary graft dysfunction compared to PCC. The 30 day and 5 year survival were higher in PCC cohort compared with DCC cohort while differences in survival at 6 months was insignificant. Conclusion Our findings do not support the aggressive application of DCC. DCC should be cautiously applied since its association with worse perioperative outcomes and higher mortality. But it remains the life-saving steps under dangerous circumstances.
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Affiliation(s)
- Cheng Chen
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.,Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Quan Zheng
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Dongsheng Wu
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Yongxiang Song
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Gang Xu
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.
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Elgharably H, Javorski MJ, McCurry KR. Bilateral sequential lung transplantation: technical aspects. J Thorac Dis 2022; 13:6564-6575. [PMID: 34992835 PMCID: PMC8662466 DOI: 10.21037/jtd-2021-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/02/2021] [Indexed: 12/02/2022]
Abstract
The surgical technique for lung transplantation has evolved dramatically over the last three decades. Significant improvements in short term outcomes in the early years of lung transplantation were due, in large part, to techniques developed to reduce airway anastomotic complications in single lung transplantation. Following development of the technique of en bloc double lung transplantation, evolution to the bilateral sequential technique further reduced airway complications for double lung transplantation. More recently, some programs have utilized the en bloc double lung transplant technique with bronchial artery revascularization to aid airway healing and potentially improve short- and long-term outcomes. The experience with bronchial artery revascularization remains limited to a few series, with the technique having not been widely adopted by most lung transplant programs. With the implementation of priority allocations schemes in many countries, patients with higher risk profiles are being prioritized for transplantation which results in more complex procedures in fragile recipients with multiple comorbidities. This includes the increased need for concomitant cardiac procedures as well as performing lung transplantation after prior cardiothoracic surgery. Different surgical approaches have been described for bilateral sequential lung transplantation with or without intra-operative mechanical circulatory support (MCS), such as sternotomy, clamshell (bilateral anterior thoracotomies with transverse sternotomy), and bilateral thoracotomy incisions. Herein, we aim, not only to describe the various surgical approaches for double lung transplantation, but to provide a comprehensive review of other aspects related to the recipient pathology and different anatomical variants as well as handling technical challenges that might be encountered during the procedure.
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Affiliation(s)
- Haytham Elgharably
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Michael J Javorski
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kenneth R McCurry
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Yang Z, Takahashi T, Gerull WD, Hamilton C, Subramanian MP, Liu J, Meyers BF, Kozower BD, Patterson GA, Nava RG, Hachem RR, Witt CA, Aguilar PR, Pasque MK, Byers DE, Kulkarni HS, Kreisel D, Puri V. Impact of Nighttime Lung Transplantation on Outcomes and Costs. Ann Thorac Surg 2020; 112:206-213. [PMID: 33065051 DOI: 10.1016/j.athoracsur.2020.07.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 06/10/2020] [Accepted: 07/06/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous studies in the field of organ transplantation have shown a possible association between nighttime surgery and adverse outcomes. We aim to determine the impact of nighttime lung transplantation on postoperative outcomes, long-term survival, and overall cost. METHODS We performed a single-center retrospective cohort analysis of adult lung transplant recipients who underwent transplantation between January 2006 and December 2017. Data were extracted from our institutional Lung Transplant Registry and Mid-America Transplant services database. Patients were classified into 2 strata, daytime (5 AM to 6 PM) and nighttime (6 PM to 5 AM), based on time of incision. Major postoperative adverse events, 5-year overall survival, and 5-year bronchiolitis obliterans syndrome-free survival were examined after propensity score matching. Additionally we compared overall cost of transplantation between nighttime and daytime groups. RESULTS Of the 740 patients included in this study, 549 (74.2%) underwent daytime transplantation and 191 (25.8%) underwent nighttime transplantation (NT). Propensity score matching yielded 187 matched pairs. NT was associated with a higher risk of having any major postoperative adverse event (adjusted odds ratio, 1.731; 95% confidence interval, 1.093-2.741; P = .019), decreased 5-year overall survival (adjusted hazard ratio, 1.798; 95% confidence interval, 1.079-2.995; P = .024), and decreased 5-year bronchiolitis obliterans syndrome-free survival (adjusted hazard ratio, 1.556; 95% confidence interval, 1.098-2.205; P = .013) in doubly robust multivariable analyses after propensity score matching. Overall cost for NT and daytime transplantation was similar. CONCLUSIONS NT was associated with a higher risk of major postoperative adverse events, decreased 5-year overall survival, and decreased 5-year bronchiolitis obliterans syndrome-free survival. Our findings suggest potential benefits of delaying NT to daytime transplantation.
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Affiliation(s)
- Zhizhou Yang
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri
| | - Tsuyoshi Takahashi
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri
| | - William D Gerull
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri
| | - Christy Hamilton
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri
| | - Melanie P Subramanian
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri
| | - Jingxia Liu
- Department of Surgery, Washington University, St Louis, Missouri
| | - Bryan F Meyers
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri
| | - Benjamin D Kozower
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri
| | - G Alexander Patterson
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri
| | - Ruben G Nava
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri
| | - Ramsey R Hachem
- Division of Pulmonology and Critical Care, Washington University, St Louis, Missouri
| | - Chad A Witt
- Division of Pulmonology and Critical Care, Washington University, St Louis, Missouri
| | - Patrick R Aguilar
- Division of Pulmonology and Critical Care, Washington University, St Louis, Missouri
| | - Michael K Pasque
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri
| | - Derek E Byers
- Division of Pulmonology and Critical Care, Washington University, St Louis, Missouri
| | - Hrishikesh S Kulkarni
- Division of Pulmonology and Critical Care, Washington University, St Louis, Missouri
| | - Daniel Kreisel
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri
| | - Varun Puri
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St Louis, Missouri.
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7
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Moraes JLS, Oliveira RA, Samano MN, Poveda VDB. A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Lung Transplant. Prog Transplant 2020; 30:329-334. [PMID: 32930051 DOI: 10.1177/1526924820958133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are among the leading health care-associated infections as well as a major problem in the postoperative period of lung transplant recipients. Little is known about the risk factors in this specific population. The objective of this study was to identify the incidence, risk factors, and outcomes of SSI following lung transplant. METHODS Digital medical records of adult recipients subjected to lung transplant from July 2011 and June 2016 in a large Brazilian referral teaching public center were analyzed in this retrospective cohort follow-up. RESULTS Among the 121 recipients analyzed, 19 (15.7%) had SSI; of these, 11 (57.8%) had superficial incisional infections, 1 (5.2%) had a deep incisional infection, and 7 (36.8%) had organ/space infection. Recipient-related risk factors for SSI were high body mass index (P = .041), prolonged surgery time (P = .043), and prolonged duration of chest drain placement (P = .009). At the multiple logistic regression was found that each hour elapsed in the surgical time increased the odds of SSI by around 2 times (odds ratio 2.34; 95% CI, 1.46-4.53; P = .002). Donor-related risk factors included smoking status (P = .05) and positive bronchoalveolar lavage (P < .001). Having an SSI was associated with an increased length of stay in intensive care units (P = .003), reoperation (P = .014), and a higher 1-year mortality rate (P = .02). CONCLUSIONS The identified incidence rate was higher to that observed in the previous studies. The risk factors duration of chest tube placement and donor smoking status are different from those reported in the scientific literature.
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8
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Ungerman E, Khoche S, Subramani S, Bartels S, Fritz AV, Martin AK, Subramanian H, Devarajan J, Knight J, Boisen ML, Gelzinis TA. The Year in Cardiothoracic Transplantation Anesthesia: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2020; 34:2889-2905. [PMID: 32782193 DOI: 10.1053/j.jvca.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 11/11/2022]
Abstract
The highlights in cardiothoracic transplantation focus on the recent research pertaining to heart and lung transplantation, including expansion of the donor pool, the optimization of donors and recipients, the use of mechanical support, the perioperative and long-term outcomes in these patient populations, and the use of transthoracic echocardiography to diagnose rejection.
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Affiliation(s)
- Elizabeth Ungerman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Swapnil Khoche
- Department of Anesthesiology, University of California San Diego, San Diego, CA
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Steven Bartels
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, FL
| | - Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, FL
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Joshua Knight
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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Extracorporeal Membrane Oxygenation to Overcome Graft-Cavity Disparity of Lung Transplantation. Ann Thorac Surg 2020; 109:e275-e277. [DOI: 10.1016/j.athoracsur.2019.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/21/2019] [Accepted: 07/05/2019] [Indexed: 11/19/2022]
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11
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Rafiroiu S, Hassouna H, Ahmad U, Koval C, McCurry KR, Pettersson GB, Ibrahim M, Johnston DR, Budev M, Murthy SC, Toth AJ, Blackstone EH, Tong MZ. Consequences of Delayed Chest Closure During Lung Transplantation. Ann Thorac Surg 2020; 109:277-284. [DOI: 10.1016/j.athoracsur.2019.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 07/25/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
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12
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Yoshinaga D, Baba S, Hirata T, Fukushima H, Hamaji M, Aoyama A, Chen-Yoshikawa TF, Yamagishi H, Date H, Heike T. Living-donor lung transplantation after surgical repair of transposition of the great arteries. Gen Thorac Cardiovasc Surg 2018; 67:640-643. [PMID: 30191531 DOI: 10.1007/s11748-018-1006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 09/02/2018] [Indexed: 11/28/2022]
Abstract
Pediatric pulmonary hypertension after surgery for congenital heart disease is a significant complication. We present a case of living-donor lung transplantation for a 12-year-old girl with pulmonary hypertension after surgical repair of transposition of great arteries. Despite repairing the transposition of great arteries, her growth was severely restricted because of progressive pulmonary hypertension; thus, lung transplantation was discussed. Standard bilateral lobar transplantation seemed unfeasible due to oversized grafts, so we performed a single lobar transplantation. Unexpectedly, she developed complications and died 3 months postoperatively despite another emergent lobar transplantation. We discussed the challenges and potential solutions regarding lobar size mismatching.
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Affiliation(s)
- Daisuke Yoshinaga
- Department of Pediatrics, Graduate School of Medicine, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Shiro Baba
- Department of Pediatrics, Graduate School of Medicine, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.
| | - Takuya Hirata
- Department of Pediatrics, Graduate School of Medicine, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Hiroyuki Fukushima
- Department of Pediatrics, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Toyofumi F Chen-Yoshikawa
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Hiroyuki Yamagishi
- Department of Pediatrics, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Toshio Heike
- Department of Pediatrics, Graduate School of Medicine, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
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13
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Ma J, Zhao J, Bai Q, He S, Yu J, Gou Y. [Application of VSD in 6 Cases of Postoperative Infection
-A Clinical Experience Sharing]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:343-347. [PMID: 29587923 PMCID: PMC5973333 DOI: 10.3779/j.issn.1009-3419.2018.04.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
背景与目的 手术切口感染是胸外科术后常见并发症之一,其危害与感染程度、部位等相关,轻者致局部疼痛、住院时间延长、费用增加,重者可导致严重感染,甚至感染性休克、危及生命。因此,妥善处理切口感染,有利于促进恢复、降低疾病负担、奠定进一步治疗良好基础。切口感染传统外科处理措施包括彻底引流、加强换药、使用抗生素等,存在治疗过程长、治疗效果不确切等不足。本研究对我科6例胸部手术术后发生感染患者尝试性使用负压封闭引流装置(vacuum sealing drainage, VSD)的经验进行总结,以期改进传统应对患者胸部手术术后感染的处理模式。 方法 对我院近一年来出现胸部手术术后切口感染或手术切口瘘的患者相关临床数据进行回顾和总结,选择了其中6例使用VSD材料治疗术后感染的患者,对其使用VSD处理的过程和最终临床结果进行总结讨论。 结果 本研究中所有患者在使用VSD后6 h-10 h内发热、伤口渗出症状消失。7天-10天后拔除引流装置,5例患者创面感染情况明显改善,伤口分泌物消失,手术切缘肉芽组织生长良好,二期手术关闭胸腔和皮肤。1例患者感染严重,去除VSD后分泌物仍较多,效果不明显,再次放置VSD装置,7天后去除VSD装置,患者手术切口无渗出,肉芽组织生长良好,二期手术关闭胸腔和皮肤。所有6例患者最终感染症状缓解,症状改善,手术切口愈合良好出院。2例食管癌患者中,平均手术时间427.5 min,术后平均住院天数40天,术后平均换药次数8.5次,住院期间平均总花费111, 893.47元;4例慢性脓胸患者中,平均手术时间192.5 min,术后平均住院天数27.75天,术后平均换药次数5.5次,住院期间平均总花费48, 237.71元。 结论 VSD在处理胸外科手术术后切口感染患者中效果良好,减少了患者的痛苦和负担,保证了发生术后感染患者的生活质量。
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Affiliation(s)
- Jilong Ma
- Gansu University of Traditional Chinese Medicine, Lanzhou 730000, China.,Gansu Provincial Hospital, Lanzhou 730000, China
| | - Jing Zhao
- The first people's Hospital of Lanzhou, Lanzhou 730000, China
| | - Qizhou Bai
- Gansu Provincial Hospital, Lanzhou 730000, China
| | | | - Jun Yu
- Gansu Provincial Hospital, Lanzhou 730000, China
| | - Yunjiu Gou
- Gansu Provincial Hospital, Lanzhou 730000, China
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