Normalized Pulmonary Artery Diameter Predicts Occurrence of Postpneumonectomy Respiratory Failure, ARDS, and Mortality

Hypothesizing that pulmonary artery diameter is a marker of subclinical pulmonary hypertension, we assessed its impact on postoperative outcome in patients requiring pneumonectomy. Morphometric, clinical, and laboratory data were retrospectively retrieved from files of 294 consecutive patients treated by pneumonectomy for malignancy (289 NSCLC). Pulmonary artery was measured at bifurcation level on CT scan and normalized by body surface area. Median normalized pulmonary artery diameter (cut-off for analyses) was 14 mm/m2. Postoperatively, 46 patients required re-do intubation and 30 had acute respiratory distress syndrome (ARDS). Multivariate analysis showed that Charlson Comorbidity Index >5 (p= 0.0009, OR 3.8 [1.76-8.22]), right side of pneumonectomy (p= 0.013, OR 2.37 [1.20-4.71]), and higher normalized pulmonary artery diameter (p= 0.029, OR 2.16 [1.08-4.33]) were independent predictors of re-do intubation, while Charlson Comorbidity Index >5 (p= 0.018, OR 2.55 [1.17-5.59]) and higher normalized pulmonary artery diameter (p= 0.028, OR = 2.52 [1.10-5.77]) were independently associated with occurrence of ARDS. Post-operative mortality was 8.5%. Higher normalized pulmonary artery diameter, (p= 0.026, OR 3.39 [1.15-9.95]), right side of pneumonectomy (p= 0.0074, OR 4.11 [1.46-11.56]), and Charlson Comorbidity Index >5 (p= 0.0011, OR 5.56 [1.99-15.54]) were independent predictors of postoperative death. We conclude that pre-operative normalized pulmonary artery diameter predicts the risk of re-do intubation, ARDS and mortality in patients undergoing pneumonectomy for cancer.