Lung Transplantation in Pulmonary Hypertension: A Multidisciplinary Unit's Management Experience.

BACKGROUND: Prognosis assessment of pulmonary hypertension (PH) is multifactorial and placement of patients on the lung transplantation (LT) waiting list requires the weighing of a complex set of criteria. The aim of this retrospective cohort study was to analyze a series of patients treated in our unit at the moment of their inclusion on the LT waiting list and long-term survival after LT. MATERIAL AND METHODS: Baseline characteristics, LT outcomes, and survival were evaluated in all patients diagnosed with pulmonary arterial hypertension (PAH) and pulmonary veno-occlusive disease (PVOD) who were included on the LT waiting list in 2011-2016. RESULTS: Thirty-three patients were listed with a diagnosis of PAH or PVOD. Patients had an average age of 43 ± 12 years and 71% were female. The median time between PAH diagnosis and inclusion on the LT waiting list was 62.5 months (interquartile range [IQR], 6-93.3 months). Twenty-eight patients (84%) underwent double LT. The difference between the waiting time in urgent cases (1.5 months; IQR, 0.4-4.2 months) and in elective cases (7.4 months; IQR, 2.7-16.2 months) was significant (P < .049). The 28 patients with PAH/PVOD in our hospital had a 95% short-term survival after LT both at 1 and at 3 months, without variance between urgent and elective LT. Longer-term survival rate was 84% both at 12 and 36 months. CONCLUSIONS: There is great complexity in determining the appropriate time for transplantation referral and inclusion on the waiting list for patients with PAH/PVOD so that LT can be more realistically incorporated into the treatment algorithm for PAH. LT offers a good short- and long-term survival in patients with PAH/PVOD.

[Octreotide for conservative management of postoperative chylothorax]. / Tratamiento conservador con octreótido del quilotórax posquirúrgico.

Postoperative chylothorax after lung resection is a major problem leading to morbidity and mortality and requiring reoperation in a large number of cases. The most advisable and least aggressive option is conservative management in progressive stages: a diet rich in medium-chain fatty acids and/or total parenteral nutrition, in addition to chest tube drainage. Including octreotide in this regimen seems to be related to a higher success rate without the need for surgery. We report a case in which the effectiveness and safety of octreotide in the resolution of postoperative chylothorax was excellent.

[Technical complications in the surgical inspection of the mediastinum in the staging of cancer of the lung]. / Complicaciones técnicas de la exploración quirúrgica del mediastino en la estadificación del cáncer de pulmón.

Between January 1974 and December 1996 we performed exploratory surgery (mediastinoscopies/mediastinotomies) on 1,618 patients diagnosed of bronchogenic carcinoma who were considered functionally operable and whose cancer was believed to be resectable. Findings were positive in 26%. Thirty-four (2.1%) complications were encountered, with a significantly higher incidence of complication among those for whom the results of exploratory surgery were positive (p = 0.004) as follows: only 13 cases (0.8%) of significant bleeding; 12 cases (0.74%) of recurrent left nerve palsy (0.74%), 4 (0.25%) subcutaneous wound infections; 3 cases (0.18%) of pneumothorax; 1 (0.06%) perforated esophagus; and 1 case (0.06%) of chylomediastinum. The rate of morbidity associated with exploratory surgery was within the range reported in the literature. No deaths occurred. Mediastinoscopy, in our experience, is the most effective way of staging mediastinal ganglia. Provided the procedure is performed carefully by experienced surgeons, the risk of complication is minimal.

[Surgical diagnostic procedures in superior vena cava syndrome]. / Procedimientos quirúrgicos diagnósticos en el síndrome de vena cava superior.

We evaluate surgical risk and efficacy in a series of 29 patients referred to us over a 22-year period with diagnoses of superior vena cava syndrome (SVCS) requiring surgical removal of histology specimens. We did 34 procedures: 23 mediastinoscopies, 6 mediastinotomies, 2 thoracotomies, 2 sternotomies and 1 Daniel's biopsy procedure. Mean surgical time was 88 minutes. There were no serious surgical complications and no deaths. Histological diagnoses (27 malignant and 2 benign) were obtained for all patients. The efficacy of mediastinoscopy was 82.6% whereas the efficacy of mediastinotomy was 66.6%. We believe that diagnostic surgical procedures in patients with SVCS are safe and effective. The use of blind radiation therapy is unjustified, given that some patients present benign processes or malignant ones that are more responsive to chemotherapy. Moreover, subsequent histologic confirmation can be made more difficult after blind radiation.