{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:09:40Z","timestamp":1790892580499,"version":"4.1.0"},"reference-count":25,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,5,29]],"date-time":"2021-05-29T00:00:00Z","timestamp":1622246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Center for Cardiovascular Research","award":["01\/20121"],"award-info":[{"award-number":["01\/20121"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The study was approved by the institutional review board (IRB) at the University Medical Center Campus Kiel, Kiel, Germany (reference number: AZ D 559\/18) and registered at the German Clinical Trials Register (reference number: DRKS00022222). Objective. Unilateral pulmonary edema (UPE) is a complication after minimally invasive mitral valve surgery (MIMVS). We analyzed the impact of this complication on the short- and long-term outcome over a 10-year period. Methods. We retrospectively observed 393 MIMVS patients between 01\/2009 and 12\/2019. The primary endpoint was a radiographically and clinically defined UPE within the first postoperative 24 h, secondary endpoints were 30-day and long-term mortality and the percentage of patients requiring ECLS. Risk factors for UPE incidence were evaluated by logistic regression, and risk factors for mortality in the follow-up period were assessed by Cox regression. Results. Median EuroSCORE II reached 0.98% in the complete MIMVS group. Combined 30-day and in-hospital mortality after MIMVS was 2.0% with a 95, 93 and 77% survival rate after 1, 3 and 10 years. Seventy-two (18.3%) of 393 patients developed a UPE 24 h after surgery. Six patients (8.3%) with UPE required an extracorporeal life-support system. Logistic regression analysis identified a higher creatinine level, a worse LV function, pulmonary hypertension, intraoperative transfusion and a longer aortic clamp time as predictors for UPE. Combined in hospital mortality and 30-day mortality was slightly but not significantly higher in the UPE group (4.2 vs. 1.6%; p = 0.17). Predictors for mortality during follow-up were age \u2265 70 years, impaired RVF, COPD, drainage loss \u2265 800 mL and length of ventilation \u2265 48 h. During a median follow-up of 4.6 years, comparable survival between UPE and non-UPE patients was seen in our analysis after 5 years (89 vs. 88%; p = 0.98). Conclusions. In-hospital outcome with UPE after MIMVS was not significantly worse compared to non-UPE patients, and no differences were observed in the long-term follow-up. However, prolonged aortic clamp time, worse renal and left ventricular function, pulmonary hypertension and transfusion are associated with UPE.<\/jats:p>","DOI":"10.3390\/jcm10112411","type":"journal-article","created":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T01:51:37Z","timestamp":1622425897000},"page":"2411","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Outcome of Unilateral Pulmonary Edema after Minimal-Invasive Mitral Valve Surgery: 10-Year Follow-Up"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4990-1892","authenticated-orcid":false,"given":"Thomas","family":"Puehler","sequence":"first","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany"},{"name":"DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg\/Kiel\/L\u00fcbeck, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Friedrich","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Lutter","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany"},{"name":"DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg\/Kiel\/L\u00fcbeck, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maike","family":"Kornhuber","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0106-8205","authenticated-orcid":false,"given":"Mohamed","family":"Salem","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Schoettler","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Ernst","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University-Medical-Center Schleswig-Holstein, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatim","family":"Seoudy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University-Medical-Center Schleswig-Holstein, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derk","family":"Frank","sequence":"additional","affiliation":[{"name":"DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg\/Kiel\/L\u00fcbeck, D-24105 Kiel, Germany"},{"name":"Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University-Medical-Center Schleswig-Holstein, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Schoeneich","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Cremer","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany"},{"name":"DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg\/Kiel\/L\u00fcbeck, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assad","family":"Haneya","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1055\/s-0040-1710569","article-title":"German Heart Surgery Report 2019: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery","volume":"68","author":"Beckmann","year":"2020","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.1093\/eurheartj\/ehx391","article-title":"2017 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"38","author":"Falk","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1177\/1089253211434591","article-title":"Anesthetic considerations during minimally invasive mitral valve surgery","volume":"16","author":"Vernick","year":"2012","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_4","first-page":"774","article-title":"How to start a minimal access mitral valve program","volume":"2","author":"Hunter","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1097\/HCO.0b013e328350214f","article-title":"Should complex mitral valve repair be routinely performed using a minimally invasive approach?","volume":"27","author":"Anyanwu","year":"2012","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1111\/j.1540-8191.2009.00813.x","article-title":"Unilateral re-expansion pulmonary edema: A rare complication following one-lung ventilation for minimal invasive mitral valve reconstruction","volume":"24","author":"Madershahian","year":"2009","journal-title":"J. Card. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1093\/ejcts\/ezu312","article-title":"Unilateral Pulmonary Oedema After Minimally Invasive Cardiac Surgery via Right Anterolateral Minithoracotomy","volume":"47","author":"Keyl","year":"2015","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.athoracsur.2014.07.067","article-title":"Unilateral postoperative pulmonary edema after minimally invasive cardiac surgical procedures: A case-control study","volume":"99","author":"Tutschka","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1093\/ejcts\/ezx399","article-title":"Unilateral pulmonary oedema after minimally invasive mitral valve surgery: A single-centre experience","volume":"53","author":"Renner","year":"2018","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_10","first-page":"504","article-title":"Unilateral pulmonary oedema after minimally invasive and robotically assisted mitral valve surgery","volume":"57","author":"Vento","year":"2020","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/00005382-199601130-00004","article-title":"Reexpansion pulmonary edema","volume":"11","author":"Tarver","year":"1996","journal-title":"J. Thorac. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/S0195-668X(02)00799-6","article-title":"The logistic EuroSCORE","volume":"24","author":"Roques","year":"2003","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/j.1540-8191.1998.tb01070.x","article-title":"Port-Access Mitral Valve Surgery: Summary of Results","volume":"13","author":"Colvin","year":"1998","journal-title":"J. Card. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s13019-018-0719-4","article-title":"Does full sternotomy have more significant impact than the cardiopulmonary bypass time in patients of mitral valve surgery?","volume":"13","author":"Qiu","year":"2018","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1093\/ejcts\/ezv089","article-title":"Re-expansion pulmonary oedema after minimally invasive cardiac surgery with right mini-thoracotomy","volume":"49","author":"Irisawa","year":"2016","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e375","DOI":"10.1016\/j.athoracsur.2019.10.073","article-title":"Preventive Strategy for Reexpansion Pulmonary Edema After Minimally Invasive Cardiac Surgery","volume":"109","author":"Inoue","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1111\/trf.15311","article-title":"A consensus redefinition of transfusion-related acute lung injury","volume":"59","author":"Vlaar","year":"2019","journal-title":"Transfusion"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1053\/j.jvca.2011.09.028","article-title":"Characterization of pulmonary and systemic inflammatory responses produced by lung re-expansion after one-lung ventilation","volume":"26","author":"Leite","year":"2012","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1177\/0267659119847917","article-title":"Minimal volume ventilation during robotically assisted mitral valve surgery","volume":"34","author":"Vento","year":"2019","journal-title":"Perfusion"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"164","DOI":"10.3348\/kjr.2010.11.2.164","article-title":"High-resolution CT findings of re expansion pulmonary edema","volume":"11","author":"Baik","year":"2010","journal-title":"Korean. J. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1161\/CIRCIMAGING.113.001859","article-title":"Reference ranges of blood flow in the major vessels of the normal human fetal circulation at term by phase-contrast magnetic resonance imaging","volume":"7","author":"Prsa","year":"2014","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/j.1540-8191.2009.00823.x","article-title":"Lung dysfunction following cardiopulmonary bypass","volume":"25","author":"Apostolakis","year":"2010","journal-title":"J. Card. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"H1283","DOI":"10.1152\/ajpheart.00251.2010","article-title":"Lung ischemia-reperfusion injury: A molecular and clinical view on a complex pathophysiological process","volume":"299","author":"Gielis","year":"2010","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1007\/s00134-004-2379-1","article-title":"Hydrostatic mechanisms may contribute to the pathogenesis of human re-expansion pulmonary edema","volume":"30","author":"Sue","year":"2004","journal-title":"Intensive Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1007\/s00134-016-4326-3","article-title":"Experts\u2019 opinion on management of hemodynamics in ARDS patients: Focus on the effects of mechanical ventilation","volume":"42","author":"Matthay","year":"2016","journal-title":"Intensive Care Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/11\/2411\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:10:26Z","timestamp":1760163026000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/11\/2411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,29]]},"references-count":25,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["jcm10112411"],"URL":"https:\/\/doi.org\/10.3390\/jcm10112411","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,29]]}}}