Back to Search
Start Over
iIteratrial shunting through an asymptomatic patent foramen ovale in thoracic surgery
- Publication Year :
- 2019
- Publisher :
- Elsevier Inc., 2019.
-
Abstract
- Background Patent foramen ovale (PFO) is present in as many as 25% of the general population and is considered an irrelevant condition in healthy subjects. Here, we sought to determine an association between an asymptomatic PFO at baseline and postoperative short-term adverse events in patients undergoing major pulmonary resection for lung cancer. In addition, we evaluated for the rate of PFO after pulmonary resections. Methods This prospective, observational study assessed patients by transcranial Doppler with contrast at baseline and discharge. To confirm interatrial shunting, patients with positive transcranial Doppler at baseline also underwent contrast transthoracic echocardiography. Multivariate logistic regression models were adopted to investigate for independent factors that could have been associated with complications. Backward stepwise procedure was used for model selection. Results Median age was 67.7 ± 9.2 years (range, 36 to 86), and 67% were men. Overall, 18 patients underwent pneumonectomy, 11 bilobectomy, and 118 lobectomy; 54% underwent right-sided procedure and 46%, left-sided. One perioperative death was recorded, and 34 patients had one or more cardiopulmonary complications. At baseline, PFO was positive in 25% (37 of 147) and negative in 75% (110 of 147); of the latter, 11% were positive at discharge. Detection of PFO at baseline, on multivariate analysis, was significantly associated with a risk of postoperative complications (odds ratio 2.5; 95% confidence interval: 1.1 to 5.8). Specifically, we observed a significant association between atrial fibrillation and positive PFO at baseline (odds ratio 3.5; 95% confidence interval: 1.4 to 9.0). Conclusions Preoperative asymptomatic PFO was independently associated with postoperative adverse events. Moreover, 11% of patients who had negative transcranial Doppler studies at baseline had asymptomatic PFOs at discharge. Larger prospective studies are needed to further investigate for a prognostic impact of PFO in thoracic surgery.
- Subjects :
- Male
Lung Neoplasms
Ultrasonography, Doppler, Transcranial
medicine.medical_treatment
atrial fibrillation (AF)
patent foramen ovale (PFO)
perioperative management
postoperative complications
risk factors in surgery
030204 cardiovascular system & hematology
0302 clinical medicine
Carcinoma, Non-Small-Cell Lung
Prospective Studies
Prospective cohort study
Aged, 80 and over
education.field_of_study
Middle Aged
Treatment Outcome
Italy
Cardiothoracic surgery
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
Pulmonary and Respiratory Medicine
Adult
medicine.medical_specialty
Population
Foramen Ovale, Patent
Asymptomatic
Disease-Free Survival
03 medical and health sciences
Pneumonectomy
Internal medicine
medicine
Humans
Heart Atria
education
Aged
business.industry
Odds ratio
Thoracic Surgical Procedures
medicine.disease
Survival Analysis
Transcranial Doppler
030228 respiratory system
Asymptomatic Diseases
Patent foramen ovale
Surgery
business
Echocardiography, Transesophageal
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....b969c9c20c2ca1fcd14e0576bb7c9800