Efficacy, predictors of success and failure of an updated lateral pharyngoplasty approach as an independent procedure in treating obstructive sleep apnea with CPAP failures.

PURPOSE: To assess predictors of success and failure of an updated lateral pharyngoplasty as an independent procedure in treating obstructive sleep apnea with CPAP failures. METHODS: Forty-six patients with known OSAS who were resistant to CPAP or failures were included. BMI, Stop-Bang score, and sleep study data were recorded before and after the updated Cahali pharyngoplasty procedure. Pre-operative DISE was done for all cases; however, postoperative DISE was done only for non-responders. RESULTS: Successful operation outcomes achieved in 69.6% (32 cases) and 30.4% (14 cases) were failure rates. Postoperative snoring index, Stop Bang score, and AHI were significantly decreased compared to pre-operative data (p value < 0.001). There is statistically a significant increase in minimal and baseline SpO2 postoperatively (p value < 0.001). Patients with no laryngeal collapse (L0) predict operation success. However, patients with high pre-operative snoring index, collapse at lateral wall hypopharynx, high tongue collapse, laryngeal collapse, tongue palate interaction, and low grades tonsils (1, 2) predict the failure of the surgery (p value = 0.006*,0.024*,0.047*, respectively). CONCLUSION: Updated Cahali lateral pharyngoplasty could not be used as an independent procedure in all OSA patients. The lack of laryngeal collapse (L0) is a considerable success predictor for the procedure. However, the pre-operative low-grade tonsils (1, 2) and high snoring index predict operation failure.

Managing obstructive sleep apnea patients with CPAP failure with a novel Lateral Pharyngoplasty as a stand-alone procedure.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is caused by a complete or partial obstruction of the upper airway. A new Cahali lateral pharyngoplasty as a stand-alone procedure for the treatment of OSA patients, whatever the level and pattern of airway obstruction in patients with CPAP failure or non-compliant patients, is it? PATIENTS AND METHODS: 40 patients with known OSAS non-compliant with CPAP or CPAP failures included. BMI, Stop-Bang score, and sleep study parameters were reported before and after the new Cahali pharyngoplasty operation. Preoperative DISE was done for all cases. RESULTS: There were 28 (70%) cases with successful operation outcomes, and 12 (30%) failed cases. Postoperative Stop Bang score, AHI, snoring index were significantly reduced in comparison to preoperative data (p-value <0.001); however, minimal SpO2 and baseline SpO2 were significantly increased in comparison to preoperative data. There was a significant improvement in AHI postoperative. Patients collapse at the level of lateral wall hypopharynx, high tongue collapse, laryngeal collapse, tongue palate interaction, all significantly predict failure outcome of the operation (p-value = 0.022). However, the absence of laryngeal collapse (L0) had a successful prediction outcome. The high snoring index significantly predicts operation failure. However, preoperative high baseline SpO2 predicts operation success significantly. CONCLUSION: The new Cahali lateral pharyngoplasty can be used as a stand-alone procedure in the absence of lateral wall collapse at the level of the hypopharynx (LH), high tongue base collapse (TH), laryngeal collapse (L1) or tongue palate interaction.

Open Versus Closed Pleura Internal Mammary Artery Harvesting and Early Pulmonary Function After Coronary Artery Bypass Grafting.

BACKGROUND: The internal mammary artery is the vessel of choice for myocardial revascularisation during coronary artery bypass grafting (CABG). Although it is possible to harvest the left internal mammary artery (LIMA) without opening the left pleura, pleurotomy is usually performed to provide adequate exposure and allow the placement of the LIMA medial to the upper lobe, preventing any undue tension on the mammary pedicle. However, the intact pleura technique may have a lower risk of postoperative pulmonary complications. We aimed to study the effects of both procedures on pulmonary function and the incidence of complications. METHOD: One hundred patients with ischaemic heart disease indicated for CABG were included and divided into two groups. The closed pleural technique group included 50 patients with preservation of the pleural integrity during mammary harvesting. The open pleural procedure group included 50 patients without preservation of pleural integrity. Spirometry was done pre- and postoperatively in both groups and postoperative pulmonary complications in both groups were recorded and analysed. RESULTS: Internal mammary harvesting with preservation of pleural integrity during CABG in patients in the closed pleural procedure group showed significant improvement in forced expiratory volume in the first second (FEV1%), forced vital capacity (FVC%), and FEV1/FVC compared with the corresponding values in patients in the open pleural procedure group, on day 5 postoperatively, at discharge, and at day 30. There were fewer complications in preservation of pleural integrity with regard to lung atelectasis and pleural effusion, which were significantly lower in patients in the open pleural procedure group. CONCLUSIONS: Preservation of pleural integrity has beneficial effects on pulmonary function and has fewer associated pulmonary complications.