Key result
Robotic approach linked to ~73% less unilateral pulmonary edema after minimally invasive mitral valve surgery.
Why the study?
Unilateral pulmonary oedema (UPO) after minimally invasive cardiac surgery lacks consistent diagnostic criteria, complicating assessment of rates and risk factors.
Cohort (n=231)
Odds Ratio: 0.27 (95% CI 0.12–0.62)
p-value: p=0.002
A reproducible radiological classification for unilateral pulmonary oedema after minimally invasive mitral valve surgery correlates with ventilation times and identifies key patient and procedural risk factors.
Supports preoperative risk stratification for unilateral pulmonary oedema after minimally invasive mitral surgery; leaves open whether robotic approaches confer protection.
OBJECTIVES: Unilateral pulmonary oedema (UPO) is a severe complication of minimally invasive cardiac surgery. UPO rates and UPO-related mortality vary considerably between different studies. Due to lack of consistent diagnostic criteria for UPO, the aim of this study was to create a reproducible radiological classification for UPO. Also, risk factors for UPO after robotic and minimally invasive mitral valve operations were evaluated. METHODS: Two hundred and thirty-one patients who underwent elective minimally invasive mitral valve surgery between January 2009 and March 2017 were evaluated. Chest radiographs of the first postoperative morning were categorized into 3 UPO grades based on the severity of radiological signs of pulmonary oedema described in this study. The radiographs were analysed by 2 independent radiologists and interobserver agreement was evaluated. The clinical significance of the classification was evaluated by comparing postoperative PaO2/FiO2 values and total ventilation times between the different UPO grades. Also, multivariable logistic regression analysis was employed to identify risk factors for UPO. RESULTS: Interobserver agreement was substantial (Kappa = 0.780). Median total ventilation times were significantly longer with increasing severity of UPO, 15 (interquartile range 12-18) h for no UPO, 18 (interquartile range 15-24) h for grade I UPO and 25 (interquartile range 21-31) h for grade II UPO. Pulmonary hypertension [adjusted odds ratios (AOR) 2.51, 95% confidence intervals (CI) 1.43-4.40; P = 0.001], moderate or severe heart failure (AOR 2.88, 95% CI 1.27-6.53; P = 0.011), body mass index (AOR 1.14, 95% CI 1.02-1.28; P = 0.017) and cardiopulmonary bypass time (AOR 1.02, 95% CI 1.01-1.03; P < 0.001) were identified as independent risk factors for UPO and robotic approach (AOR 0.27, 95% CI 0.12-0.62; P = 0.002) as protective against UPO. CONCLUSIONS: Due to the variability of the diagnostic criteria for UPO in previous studies, a radiological classification for UPO is required to reliably assess the rates and risk factors for UPO. The radiological classification described in this study demonstrated high interobserver agreement and correlated with total ventilation times and postoperative PaO2/FiO2 values.
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Kesävuori et al. (2019) conducted a cohort in Minimally invasive mitral valve surgery (n=231). Robotic approach vs. Non-robotic minimally invasive approach was evaluated on Unilateral pulmonary oedema (UPO) (AOR 0.27, 95% CI 0.12-0.62, p=0.002). A robotic approach was independently protective against unilateral pulmonary oedema after minimally invasive mitral valve surgery (AOR 0.27; 95% CI 0.12-0.62; P=0.002).
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