 |
|
|
|
Posts:
41
Registered:
9/23/08
|
|
|
|
VATS -pleurectomy- talc pleurodesis for benign effusions for CHF?
Posted:
Mar 14, 2006 7:23 AM
|
|
I try to avoid VATS pleurectomy for benign disease. I ����was always taught the failure rate is high.���� Is this changing?? I have a guy with a normal LV , moderate MR and���� pulmonary hypertension on transthoracic ECHO. He has����recurrent effusions and I'm being asked to do a pleurectomy, talc pleurodesis.���� What is the success rate for benign disease?����( They don't want me to fix the MR or investigate it any further)���� Would anybody do the VATS??
|
|
Posts:
4
Registered:
9/23/08
|
|
|
|
Re: VATS -pleurectomy- talc pleurodesis for benign effusions for CHF?
Posted:
Feb 25, 2007 2:26 PM
in response to: David Sims
|
|
Fixing the underlying etiology is paramount, hence mitral repair should be considered.
|
|
Posts:
1
Registered:
9/23/08
|
|
|
|
Re: VATS -pleurectomy- talc pleurodesis for benign effusions for CHF?
Posted:
Mar 9, 2007 5:16 PM
in response to: David Sims
|
|
Talc pleurodesis is completely acceptable in non surgical candidates with heart failure and recurrent benign effusion (very old, kachectic, refusing surgeries). Indications should be equal to malignant diseases: recurrent effusion, Karnofsky score more than 50, possible re expansion of lung. In this indications results are generally very good, with more than 90% of successes (personal experience > 20 HF cases, institutional experience > 100 cases in benign effusion and more than 1000 cases in malignant effusion).
|
|
Posts:
16
Registered:
9/23/08
|
|
|
|
Re: VATS -pleurectomy- talc pleurodesis for benign effusions for CHF?
Posted:
Mar 29, 2007 10:51 AM
in response to: David Sims
|
|
Pleurectomy is rather excessive. If the underlying condition cannot be corrected further, talc pleurodesis is reasonable. In my experience, the reults are not as good with controlling transudadtive effusions when compared with malignant or other exudative process.
|
|
Posts:
1
Registered:
6/25/09
|
|
|
|
Re: VATS -pleurectomy- talc pleurodesis for benign effusions for CHF?
Posted:
Jun 25, 2009 8:54 AM
in response to: Mark Soberman
|
|
Along the same lines, I have not had the same success using the talc spray in the OR versus talc slurry done at the bedside with a well-placed chest tube. Any comments on the talc spray?
|
|
Posts:
4
Registered:
7/31/09
|
|
|
|
Re: VATS -pleurectomy- talc pleurodesis for benign effusions for CHF?
Posted:
Jul 31, 2009 4:04 PM
in response to: David Sims
|
|
Pleurodesis for benign lesions has good result but in your case I think you should direct your effort for treating HF either medical or surgical
|
|
Posts:
4
Registered:
9/23/08
|
|
|
|
Re: VATS -pleurectomy- talc pleurodesis for benign effusions for CHF?
Posted:
Sep 19, 2009 10:37 AM
in response to: Huzaifa Shakir
|
|
the talc spray utilized via thorocosopy in the O.R. has always been the "gold standard" where ever i have been.... most of the more senior MDs (pulmonologists and surgeons-- in the community setting i'm sure) have lukewarm feelings relative to talc slurry via tube thorocostomy....
i speculate that this stems from the frustration accrued over the years of infusing a variety of different things into the pleural space with universally marginal and ususally very painful results.
there is also the idea of safety in performing this procedure in the O.R. pulmonologists ( community hospital based, i'm sure) feel much safer if the surgeon performs this procedure-- making it less likely that they will have to take the heat for that "flash pulmonary edema" or "effusion evacuation ARDS".
my own experience with talc slurry has been excellent. the biggest problem i have encountered is with the pharmacy making up an appropriate concentration of talc slurry. ( it hurts--bad-- if too concentrated-- traumatic for both the patient and the surgeon)
utilization of this technique for a benign effusion (transudative) is less commonly required... but i would be less than enthusiastic of choosing a VATS procedure for a patient who was not a candidate for surgery.
less success with talc slurry would be anticipated in this setting.
|
|
Posts:
16
Registered:
9/23/08
|
|
|
|
Re: VATS -pleurectomy- talc pleurodesis for benign effusions for CHF?
Posted:
Nov 2, 2009 4:42 PM
in response to: David Sims
|
|
Dear Dr Sims:
A little more detail on the features of the pleural effusion might help provide a spectrum of answers for your question. Reccurrent or intractable effusion? Trapped lung (complex)? Other lung issues?
Pleurectomy in this case? No. Patient may not tolerate the one lung anesthesia you need for pleurectomy. Pleurectomy is probably not needed in majority of cases. If you can peek into the pelural space in similar case you should be able to drain the effusion, break up simple loculations of fluid and free filmy adhesions to allow the lung regain and maintain optimal reexpansion. Mechanical ("surgical") abrasion of the parietal pleura, complemented with some sclerosant (sterile talc or other) should control or tone down the effusion and without the complexity of pleurectomy.
Of course, the basic valvular issue needs to be addressed.
Regards.
C. I. Okadigwe,MD
Of course the underlying problem of valvular lesion needs to be addressed
|
|
|
|
|
|
|
