Prophylactic protocol for cerebral infarction after left upper lobectomy and prospective analysis of pulmonary vein stump thrombosis.

BACKGROUND

Pulmonary vein (PV) stump thrombosis (PVST) has been proposed as a risk factor for cerebral infarction (CI) after left upper lobectomy (LUL). We developed a CI prevention protocol and aimed to evaluate its safety and efficacy, as well as to identify risk factors for PVST.

METHODS

The protocol included proximal PV ligation during surgery, routine neurological examinations, administration of subcutaneous heparin, electrocardiographic monitoring, and contrast-enhanced computed tomography (CECT) on postoperative day 7. The study involved 73 patients who underwent LUL at our hospital. We examined the incidence of CI within 4 months of surgery, postoperative atrial fibrillation (AF), other complications, and PVST. Risk factors for PVST were assessed in patients who underwent CECT.

RESULTS

No CI and no protocol-related complications occurred within 4 months of surgery. Postoperative AF occurred in 9 patients (12.3%); three of these were asymptomatic. Among the 64 patients who underwent CECT, PVST occurred in 5 (7.8%); all were treated using an anticoagulant. Multivariable analysis identified PV pocket length [odds ratio (OR), 1.29; 95% confidence interval: 1.05-1.84; P=0.01] and postoperative AF (OR, 15.18; 95% confidence interval: 1.54-334.99; P=0.02) as independent risk factors for PVST.

CONCLUSIONS

PV pocket length and postoperative AF may be associated with the development of PVST. Early postoperative CECT is useful for the early detection and management of PVST, especially in patients with postoperative AF.