Single lung transplants (SLTs) leave in place a diseased lung, a potential source of complications. Native lung pneumonectomy is occasionally indicated. We present 2 cases of native lung complications (NLCs) managed with video-assisted thoracoscopic surgery (VATS) pneumonectomy at our institution, a procedure never reported in this context before. Case 1 involves a 59-year old gentleman with refractory, invasive pulmonary aspergillosis of the native lung, 5 years after SLT for idiopathic pulmonary fibrosis. Case 2 involves a 66-year old gentleman with α-1 antitrypsin deficiency who developed severe haemoptysis and intraparenchymal haemorrhage in the native lung 12 years after SLT. A VATS pneumonectomy was performed in both cases because we believed it would facilitate wound healing and hasten recovery in immunosuppressed patients. Our short-term results align with this hypothesis. We conclude that VATS pneumonectomy is a feasible, adequate and safe procedure in this patient population; larger series are needed to draw definitive conclusions.
Objective: Controlling lipids, in particular cholesterol and low-density lipoprotein cholesterol, has been identified as a key intervention to prevent adverse systemic events in patients with a high atherosclerotic burden and claudication. It is unclear if goal-directed therapy of to achieve a decrease in cholesterol (<200 mg/dL) and in low-density lipoprotein (<100 mg/dL) will influence outcomes. The aim of study was to determine the incidence and effectiveness of statin therapy on patient and procedural outcomes after SFA interventions for claudication.Methods: A database of patients with claudication undergoing open and endovascular intervention for TransAtlantic Inter-Society Consensus II C and D femoropopliteal lesions between 2001 and 2017 was retrospectively queried. All patients were on statins at the time of the procedure. Patients were subdivided into those based on serum cholesterol and low-density lipoprotein goals: neither goal met (no effect), one of two goals met (partial), or both goals met (full). Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Factor analyses were performed using a Cox proportional hazard model for time-dependent variables.Results: There were 1973 patients (68% male; average age, 67 years) who underwent Open and endovascular treatment for symptomatic superficial femoral artery disease. Only 52% were on statins before the procedure. Both partial and full efficacy influenced 30-day outcomes and was associated with improved freedom from major adverse limb events and amputation-free survival at 5 years (Table).Conclusions: Partial or fully effective goal directed statin therapy has a significant effect on 30-day and long term outcomes in patients presenting with claudication and advanced femoropopliteal disease.
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