Marine Peretti, Rémi Hervochon, Émelyne Hamelin Canny, Kim Blanc, Aurélie Janet-Vendroux, Jean-François Régnard, Claude Guinet, Diane Damotte, Nicolas Roche, Antoine Rabbat, Antonio Bobbio, Marco Alifano
Institution : Départements de chirurgie thoracique, de soins intensifs respiratoires, de radiologie et d’anatomopathologie, hôpital Cochin, AP-HP, Paris ; université Paris-Descartes, Paris
Objectives : Hypothesizing that pulmonary artery diameter is a marker of subclinical pulmonary disease in patients requiring pneumonectomy, we assessed its impact on postoperative outcome, especially occurrence of respiratory failure and ARDS.
Methods : Morphometric, clinical, and laboratory data were retrospectively retrieved from files of 161 consecutive patients treated by pneumonectomy for NSCLC. Pulmonary artery was measured at bifurcation level at CT scan. Crude and normalized (for body surface) measures were used for analysis.
Results : All the patients had intraoperative protective ventilation and fluid restriction. Age > 70 years and increased normalized pulmonary artery diameter were associated to need of mechanical ventilation (p=0.0072 and 0.021) and occurrence of ARDS (p=0.017 and 0.039). Lower BMI, FEV1, and ppoFEV1 were also associated with need of mechanical ventilation (p=0.015, 0.021, and 0.0015, respectively), but not occurrence of ARDS. Age > 70 years (p=0.00088), increased normalized pulmonary artery diameter (p=0.041) and lower BMI (p=0.039) were associated to 120-day mortality. Neither measure of systolic pulmonary pressure at echocardiography, nor percentage of perfusion of resected lung correlated with outcome.
Multivariate analysis showed that lower ppoFEV1 and higher normalized pulmonary artery diameter were independently associated with need of mechanical ventilation (p=0.03 and 0.014, respectively), and that only normalized pulmonary artery diameter was associated with occurrence of ARDS (p=0.038). Factors independently associated with 120-day mortality were age >70 years and increased normalized pulmonary artery diameter (p=0.0042 and 0.0029, respectively).
Conclusion : Pre-operative normalized pulmonary artery diameter predicts the need of mechanical ventilation, the risk of ARDS and 120-mortality in patients undergoing pneumonectomy.