Persistent pneumothorax treatment following congenital cardiac surgery by platelet-fibrin glue.

Abstract

Persistent pneumothorax is a life-threatening complication that can occur after congenital cardiac surgery. Traditional treatment such as chest tube drainage may not be effective in managing this condition. This study presents a new minimally invasive method for treating persistent pneumothorax using platelet-rich plasma-fibrin glue (PRP-FG). The method has been successful in treating postoperative chylothorax in previous studies, and its use has decreased morbidity, mortality, and hospital stay in chylothorax patients. Ten patients with persistent pneumothorax following cardiothoracic surgery (3 TAPVC, 2 d-TGA, 2 VSD + IAA,1 TRUNCUS + TAPVC, 1 VSD + COA, 1 GLENN), who did not respond to conservative management, underwent treatment with PRP-FG. Follow-up was done for a period of 1-4years. The age and diagnoses of pneumothorax after surgery were 85.5 ± 36.0days and 62.4 ± 34.3h, respectively. Persistent pneumothorax of 8 patients (80%) was cured completely after PRP-FG injection. PRP-FG therapy was failed in two patients who died. All cured patients had a normal life without any complications during follow-up. After PRP-FG injection, 3 patients stopped bubbling at one-time injection, 3 patients stopped bubbling at two-time injection, and 2 patients stopped bubbling at three-time injection. Two patients died during treatment; in these cases, one-time injections were done which was not successful. Persistent pneumothorax after congenital-cardiac surgery can be treated successfully with PRP-FG. This bedside minimal-invasive procedure may significantly decrease the morbidity and mortality rate. Further research is needed to confirm the efficacy of this promising treatment through multicentre clinical trials.