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J Thorac Cardiovasc Surg 2008;135:1216-1219
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr S. Murthy (Cleveland, Ohio). Dr Shen and colleagues have provided a retrospective descriptive review of their experience of the surgical management of a rare but devastating complication after pneumonectomy. Although this a series of only 18 patients, it does represent the largest report of its kind. It is unfortunate that the follow-up of such a select group of patients is so incomplete, with only 13 of 17 patients who survived answering QOL questionnaires and 11 of 17 patients with full spirometric evaluation. Limited follow-up in the context of such a small study can drastically bias the interpretation of the results. To highlight this confound, the median length of stay for the 11 patients with spirometry was almost double that of the entire cohort at 11 days, and their mean length of stay was almost 40 days. Consequently, it is difficult for me to critically and meaningful evaluate the findings. However, there are other aspects of the article that are provocative and worthy of discussion, and I will direct my attention to these.

I am intrigued by the operation and am impressed that such an undertaking can be completed. Would you comment on the following technical issues. How do you size the implants, and how are cardiac hemodynamics measured intraoperatively and postoperatively to prevent cardiac tamponade, ventricular arrhythmia, or decreased venous return?

Dr Shen. The issue of how to size the implant is one that we believe is based in some ways on trial and error at the time of the operation. After the pneumonectomy space has been opened and all of the scar and adhesions have been mobilized to allow repositioning of the herniated lung back to the proper side and repositioning mediastinal structures, heart, and pericardium back to a central position, we typically have used a technique . . . [Full Text of this Article]

Related Article

Postpneumonectomy syndrome: Surgical management and long-term results

K. Robert Shen, John C. Wain, Cameron D. Wright, Hermes C. Grillo, and Douglas J. Mathisen
J. Thorac. Cardiovasc. Surg. 2008 135: 1210-1219. [Abstract] [Full Text] [PDF]