[Preoperative evaluation and risk estimation in thoracic surgery]

Mitral Valve Surgery in a Patient 50 Years after a Pneumonectomy

Background  Patients who survive long after pneumonectomy may develop heart valve disease. The consecutive operations can be complex because of the challenging anatomical conditions and the limited physiologic reserves of the patient.

Case Presentation  The subject is a 78-year-old patient who underwent a left-sided pneumonectomy for a metastasized testicular tumor 50 years ago. At 32 and 37 years postpneumonectomy, mitral regurgitation was manifested, and valve repair was performed. Bioprosthetic mitral valve replacement and tricuspid valve reconstruction became necessary 44 years postpneumonectomy. The patient was fully recovered.

Conclusion  In case of relevant heart valve disease after pneumonectomies, heart valve surgeries are feasible.

[Anesthesia in thoracic surgery]

Thoracic surgery represents a special challenge for anesthesia and requires a high level of human and material resources. Accurate knowledge of the pathophysiology is essential for selection of the anesthetic procedure, the separation of the lungs, monitoring and treatment of hemodynamics as well as for postoperative follow-up care. The increasing number of thoracic interventions and patients who are often suffering from complex diseases require close interdisciplinary cooperation between surgeons, anesthesiologists and intensive care specialists. In addition to the anesthetic techniques particular attention must be paid to the prevention of perioperative complications that can have a relevant effect on patient outcome. In particular hypoxemia during one-lung ventilation influences postoperative morbidity and mortality. Protective pulmonary ventilation strategies play an important role in prevention of postoperative acute lung injury.

[Preoperative risk evaluation from the perspective of anaesthesiology]

Medical and technical progress together with demographic changes has led to a more complex perioperative care for patients. Accordingly, an optimal preoperative assessment in particular an adequate risk evaluation is more important than ever. A recently published joint recommendation of the German Society of Anaesthesiology and Intensive Care Medicine, the German Society of Surgery and the German Society of Internal Medicine aims to reduce considerable uncertainties in the preoperative risk evaluation especially with regard to"technical tests" by providing transparent and comprehensive arrangements. Consequently, routine screening will be abandoned in favour of targeted patient and operation-oriented individual risk assessment. This approach will change the preoperative risk evaluation in a scientific, organisational and economic way. The following article on preoperative risk evaluation is based on the valuable and helpful recommendation and aims to provide additional important aspects from the perspective of anaesthesiologists.