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Pinezich MR, Mir M, Graney PL, Tavakol DN, Chen J, Hudock M, Gavaudan O, Chen P, Kaslow SR, Reimer JA, Van Hassel J, Guenthart BA, O’Neill JD, Bacchetta M, Kim J, Vunjak-Novakovic G. Lung-Mimetic Hydrofoam Sealant to Treat Pulmonary Air Leak. Adv Healthc Mater 2024; 13:e2303026. [PMID: 38279961 PMCID: PMC11102335 DOI: 10.1002/adhm.202303026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/22/2023] [Indexed: 01/29/2024]
Abstract
Pulmonary air leak is the most common complication of lung surgery, contributing to post-operative morbidity in up to 60% of patients; yet, there is no reliable treatment. Available surgical sealants do not match the demanding deformation mechanics of lung tissue; and therefore, fail to seal air leak. To address this therapeutic gap, a sealant with structural and mechanical similarity to subpleural lung is designed, developed, and systematically evaluated. This "lung-mimetic" sealant is a hydrofoam material that has alveolar-like porous ultrastructure, lung-like viscoelastic properties (adhesive, compressive, tensile), and lung extracellular matrix-derived signals (matrikines) to support tissue repair. In biocompatibility testing, the lung-mimetic sealant shows minimal cytotoxicity and immunogenicity in vitro. Human primary monocytes exposed to sealant matrikines in vitro upregulate key genes (MARCO, PDGFB, VEGF) known to correlate with pleural wound healing and tissue repair in vivo. In rat and swine models of pulmonary air leak, this lung-mimetic sealant rapidly seals air leak and restores baseline lung mechanics. Altogether, these data indicate that the lung-mimetic sealant can effectively seal pulmonary air leak and promote a favorable cellular response in vitro.
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Affiliation(s)
| | - Mohammad Mir
- Stevens Institute of Technology, Department of Biomedical Engineering
| | | | | | - Jiawen Chen
- Stevens Institute of Technology, Department of Biomedical Engineering
| | - Maria Hudock
- Columbia University, Department of Biomedical Engineering
| | | | - Panpan Chen
- Columbia University, Department of Biomedical Engineering
- Columbia University Irving Medical Center, Department of Surgery
| | - Sarah R. Kaslow
- Columbia University, Department of Biomedical Engineering
- Columbia University Irving Medical Center, Department of Surgery
| | - Jonathan A. Reimer
- Columbia University, Department of Biomedical Engineering
- Columbia University Irving Medical Center, Department of Surgery
| | - Julie Van Hassel
- Columbia University, Department of Biomedical Engineering
- Columbia University Irving Medical Center, Department of Surgery
| | | | - John D. O’Neill
- State University of New York Downstate Medical Center, Department of Cell Biology
| | - Matthew Bacchetta
- Vanderbilt University Medical Center, Department of Thoracic Surgery
- Vanderbilt University, Department of Biomedical Engineering
| | - Jinho Kim
- Stevens Institute of Technology, Department of Biomedical Engineering
| | - Gordana Vunjak-Novakovic
- Columbia University, Department of Biomedical Engineering
- Columbia University Irving Medical Center, Department of Medicine
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Lund A, Soldath P, Nodin E, Hansen HJ, Perch M, Jensen K, Hornbech K, Kalhauge A, Mortensen J, Petersen RH. Predictors of reoperation after lung volume reduction surgery. Surg Endosc 2024; 38:679-687. [PMID: 38017156 PMCID: PMC10830766 DOI: 10.1007/s00464-023-10559-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/22/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES Lung volume reduction surgery (LVRS) has proven an effective treatment for emphysema, by decreasing hyperinflation and improving lung function, activity level and reducing dyspnoea. However, postoperative air leak is an important complication, often leading to reoperation. Our aim was to analyse reoperations after LVRS and identify potential predictors. METHODS Consecutive single-centre unilateral VATS LVRS performed from 2017 to 2022 were included. Typically, 3-5 minor resections were made using vascular magazines without buttressing. Data were obtained from an institutional database and analysed. Multivariable logistic regression was used to identify predictors of reoperation. Number and location of injuries were registered. RESULTS In total, 191 patients were included, 25 were reoperated (13%). In 21 patients, the indication for reoperation was substantial air leak, 3 patients bleeding and 1 patient empyema. Length of stay (LOS) was 21 (11-33) vs. 5 days (3-11), respectively. Only 3 injuries were in the stapler line, 13 within < 2cm and 15 injuries were in another site. Multivariable logistic regression analysis showed that decreasing DLCO increased risk of reoperation, OR 1.1 (1.03, 1.18, P = 0.005). Resections in only one lobe, compared to resections in multiple lobes, were also a risk factor OR 3.10 (1.17, 9.32, P = 0.03). Patients undergoing reoperation had significantly increased 30-day mortality, OR 5.52 (1.03, 26.69, P = 0.02). CONCLUSIONS Our incidence of reoperation after LVRS was 13% leading to prolonged LOS and increased 30-day mortality. Low DLCO and resections in a single lobe were significant predictors of reoperation. The air leak was usually not localized in the stapler line.
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Affiliation(s)
- Alberte Lund
- Department of Cardiothoracic surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Patrick Soldath
- Department of Cardiothoracic surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Erika Nodin
- Department of Cardiothoracic surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Henrik Jessen Hansen
- Department of Cardiothoracic surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Michael Perch
- Department of Cardiology, Section for Lung Transplantation and Respiratory Medicine, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Jensen
- Department of Cardiology, Section for Lung Transplantation and Respiratory Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Kåre Hornbech
- Department of Cardiothoracic surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Anna Kalhauge
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Jann Mortensen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Matsumiya H, Mori M, Kanayama M, Taira A, Shinohara S, Takenaka M, Kuroda K, Ichiki Y, Tanaka F. Thickened parietal pleural covering in intractable pneumothorax: A case report. Ann Med Surg (Lond) 2022; 78:103792. [PMID: 35734683 PMCID: PMC9207032 DOI: 10.1016/j.amsu.2022.103792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction and importance Choosing the optimal surgical approach for intractable pneumothorax can be challenging for surgeons. Case presentation A case describing the management of intractable pneumothorax has been presented. Clinical discussion Resection is not suitable in a stiff lung from repeated pleurodesis, and multiple air leakage points would make it more intricate.The ideal alternative is the use of another material to cover the entire lesion. Conclusion A thickened parietal pleura covering is an effective surgical approach for intractable pneumothorax. Selecting an optimal surgical approach for intractable pneumothorax is challenging. A thickened parietal pleura covering can effectively control intractable pneumothorax. The procedure is suitable for patients with stiff lung and persistent air leakage at multiple points.
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Kawai N, Kawaguchi T, Yasukawa M, Tojo T, Sawabata N, Taniguchi S. Surgical treatment for secondary spontaneous pneumothorax: a risk factor analysis. Surg Today 2021; 51:994-1000. [PMID: 33483786 DOI: 10.1007/s00595-020-02206-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE While surgery is an effective treatment for secondary spontaneous pneumothorax (SSP), it can be difficult, because affected patients are usually in a poor general condition. The present study investigated the risk factors of postoperative complications after surgery for SSP. METHODS Eighty-eight patients with SSP who underwent surgery from January 2006 to March 2018 were investigated. Clinical data were reviewed, and a multivariate analysis was performed. RESULTS Eighty-four patients (95%) were males, and the median patient age was 72 years. Underlying lung diseases were chronic obstructive pulmonary disease in 58 patients (65.9%), interstitial pneumonia in 26 (29.5%), and others in 4 (4.5%). Postoperative complications developed in 21 patients (24%). Hospital mortality/prolonged length of stay occurred in 6 patients (7%). A multivariate analysis showed that the preoperative performance status (performance status 0-2 vs. 3, hazard ratio: 6.570, 95% confidence interval: 1.980-21.800) was an independent predictor of postoperative complications. CONCLUSION Surgery for SSP contributed to early chest tube removal and favorable outcomes. However, rare fatal events occurred, and the patient performance status was a risk factor for postoperative complications. A careful evaluation of each patient's performance status is needed to determine the need for surgical intervention for SSP.
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Affiliation(s)
- Norikazu Kawai
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
| | - Motoaki Yasukawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Takashi Tojo
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
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Cubuk S, Raubenheimer H, Cufari ME, Proli C. eComment. Should the patients' choice guide surgeons for the surgical strategy of primary spontaneous pneumothorax? Interact Cardiovasc Thorac Surg 2016; 23:195. [PMID: 27431817 DOI: 10.1093/icvts/ivw182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sezai Cubuk
- Department of Thoracic Surgery, Royal Brompton Hospital, London, UK
| | | | | | - Chiara Proli
- Department of Thoracic Surgery, Royal Brompton Hospital, London, UK
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