Combined Cardiac Surgery and Total Thyroidectomy: Our Experience and Review of the Literature

M. Testini; E. Poli; D. Lardo; G. Lissidini; A. Gurrado; G. Scrascia; P. G. Malvindi; G. Rubino; G. Piccinni; L. de Luca Tupputi Schinosa

doi:10.1055/s-0030-1249867

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2010; 58(8): 450-454
DOI: 10.1055/s-0030-1249867

Original Cardiovascular

Combined Cardiac Surgery and Total Thyroidectomy: Our Experience and Review of the Literature

M. Testini¹ , E. Poli¹ , D. Lardo¹ , G. Lissidini¹ , A. Gurrado¹ , G. Scrascia² , P. G. Malvindi² , G. Rubino³ , G. Piccinni¹ , L. de Luca Tupputi Schinosa²

¹Department of Application in Surgery of Innovative Technologies, Section of General Surgery, University Medical School of Bari, Bari, Italy
²Department of Emergency and Organ Transplantation, Section of Cardiovascular Surgery, University Medical School of Bari, Bari, Italy
³Department of Emergency and Organ Transplantation, Section of Anesthesia and Intensive Care, University Medical School of Bari, Bari, Italy

Abstract

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Abstract

Background: The prevalence of thyroid disease in patients with cardiac disease can be as high as 11.2 %. Combined thyroid and cardiovascular surgery has rarely been reported. Methods: Ten patients (6 female, 4 male, age range 51–73 years) had total thyroidectomy and cardiac surgery in the same procedure in our surgical department. Six patients had coronary artery disease; four patients had valvulopathy. The thyroid goiter was retrosternal in 6 patients. Results: Mean stay in the intensive care unit was 46.4 hours; the postoperative course was complicated by transient right laryngeal nerve palsy in one case and by transient hypocalcemia in the patients in whom a parathyroid autotransplantation was performed (n = 3). There was one case of hemodynamic compromise needing vasoactive drug support; the mean hospital stay was 8.4 days. Conclusions: Our experience and our review of the literature suggest that a single-stage procedure is safe and feasible and must be preferred to different operations as it has an acceptable peri-operative and anesthesiological risk.

Key words

cardiovascular surgery - heart disease - thyroid surgery - total thyroidectomy

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References

1 Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007; 116 1725-1735
2 Canaris G J, Manowtz N R, Mayor G, Ridgway E C. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000; 160 526-530
3 Jones T H, Hunter S M, Price A, Angelini G D. Should thyroid function be assessed before cardiopulmonary bypass operations?. Ann Thorac Surg. 1995; 59 1273-1275
4 Lithmathe J, Kurt M, Boeken U, Roehrborn A, Feindt P, Gams E. Combined cardiothoracic surgery and interventions of the para/thyroid gland. Z Kardiol. 2005; 94 28-32
5 Finlayson S R, Birkmayer J D. Cost-effectiveness analysis in surgery. Surgery. 1998; 123 151-156
6 Hill G E, Whitten C W, Landers D F. The influence of cardiopulmonary bypass on cytokines and cell-cell communication. J Cardiothorac Vasc Anesth. 1997; 11 367-375
7 Katlic M R, Wang C A, Grillo H C. Substernal goiter. Ann Thorac Surg. 1985; 39 391-399
8 Allo M D, Thompson N W. Rationale for the operative management of substernal goiters. Surgery. 1983; 94 969-977
9 Torre G, Borgonovo G, Amato A et al. Surgical management of substernal goiter: analysis of 237 patients. Am Surg. 1995; 61 826-831
10 Wolfhard U, Krause U, Walz M K, Lederbogen S. Combined interventions in heart and thyroid surgery: an example of interdisciplinary cooperation. Chirurg. 1994; 12 1107-1110
11 Abboud B, Sleilaty G, Asmar B, Jebara V. Interventions in heart and thyroid surgery: can they be safely combined?. Eur J Cardiothorac Surg. 2003; 24 712-715
12 Matsuyama K, Ueda Y, Ogino H et al. Combined cardiac surgery and total thyroidectomy: a case report. Jpn Circ J. 1999; 63 1004-1006
13 Testini M, Nacchiero M, Piccinni G et al. Total thyroidectomy is improved by loupe magnification. Microsurgery. 2004; 24 39-42
14 Testini M, Rosato L, Avenia N et al. The impact of single parathyroid gland autotransplantation during thyroid surgery on postoperative hypoparathyroidism: a multicenter study. Transplant Proc. 2007; 39 225-230
15 Testini M, Marzaioli R, Lissidini G et al. The impact of FloSeal® matrix haemostatic agent in thyroid surgery. A prospective, randomized, comparative study. Langenbecks Arch Surg. 2009; 394 837-842
16 Ladenson P W. Recognition and management of cardiovascular disease related to thyroid dysfunction. Am J Med. 1990; 88 638-641
17 Gansera B, Schmidtler F, Angelis I, Weingartner J, Spiliopulos K, Kemkes B M. Simultaneous carotid endarterectomy and cardiac surgery – additional risk factor or safe procedure?. Z Kardiol. 2004; 93 49-57
18 Evagelopoulos N, Trenz M T, Beckmann A, Krian A. Simultaneous carotid endarterectomy and coronary artery bypass grafting in 313 patients. Cardiovasc Surg. 2000; 8 31-40
19 King R C, Parrino P E, Hurst J L, Shockey K S, Tribble M D, Kron I D. Simultaneous coronary artery bypass grafting and abdominal aneurysm repair decreases stay and costs. Ann Thorac Surg. 1998; 66 1273-1276
20 Tschirkov A, Baev B, Iliev R. Simultaneous pectus and open heart surgery. Chest Surg Clin. 2000; 10 405-413
21 Danton M H, Anikin V A, Mc Manus K G, McGuigan J A, Campalani G. Simultaneous cardiac surgery with pulmonary resection: presentation of series and review of literature. Eur J Cardiothorac Surg. 1998; 13 667-672
22 Matsuzaki K, Sakai K, Sugawara H et al. A case of ascending aortic aneurysm with intrathoracic goiter [in Japanese]. Kyobu Geka [Jpn J Thorac Surg]. 2000; 53 500-502
23 Lithmathe J, Kurt M, Grabitz K, Fnoefel W T, Gams E. Simultaneous coronary artery bypass grafting, replacement of the innominate artery and subtotal thyroidectomy in a 61-year-old patient: a case report. Chin Med J. 2005; 118 699-701
24 Mehta Y, Sujatha P, Juneja R, Singh H, Sachdeva S, Trehan N. OPCAB and thyroidectomy in a patient with a severely compromised airway. J Cardiothorac Vasc Anesth. 2005; 19 79-82
25 Banker M C, Sambol J, Raina S. Management of an ascending aortic aneurysm with coronary artery disease and tracheal compression from a substernal goiter. J Card Surg. 2005; 20 177-179
26 Tang G H, Feindel C M, Gullane P J, Butany J. Combined cardiac surgery and excision of a retrosternal thyroid mass: a case report. J Card Surg. 2006; 21 281-283
27 Demirag M K, Topgül K, Sarac A, Keceligil H T. Atrial septal defect and retrosternal toxic goitre operated in the same session: a case report. Ann Thorac Cardiovasc Surg. 2007; 13 272-274
28 Koçak H, Becit N, Erkut B, Kaygin M. Combined coronary arterial bypass graft and thyroidectomy in a patient with giant goiter: how reliable is it?. Thorac Cardiovasc Surg. 2007; 55 56-58
29 Cagli K, Mustafa M, Hizarci M, Sener E. Substernal goiter. An unusual cause of respiratory failure after coronary artery bypass grafting. Tex Heart Inst J. 2005; 32 224-227
30 Sajja L R, Mannam G C, Sompalli S, Simhadri C S, Hasan A. Multinodular goiter compressing the trachea following open heart surgery. Asian Cardiovasc Thorac Ann. 2006; 14 416-417
31 Hamdan A L, Moukarbel R V, Farhat F, Obeid M. Vocal cord paralysis after open-heart surgery. Eur J Cardiothorac Surg. 2002; 21 671-674
32 Testini M, Nacchiero M, Miniello S et al. Management of retrosternal goiters: experience of a surgical unit. Int Surg. 2005; 90 61-65
33 Ohta N, Mori T. Vocal cord paralysis after surgery to the descending thoracic aorta via left postero-lateral thoracotomy. Ann Vasc Surg. 2007; 21 761-766
34 Dimarakis I, Protopapas A D. Vocal cord palsy as a complication of adult cardiac surgery: surgical correlation and analysis. Eur J Cardiothorac Surg. 2004; 26 773-775

Prof. Mario Testini, MD

Department of Application in Surgery of Innovative Technologies
Section of General Surgery
University Medical School of Bari
Policlinico

Piazza G. Cesare

70124 Bari

Italy

Phone: +39 08 05 59 28 82

Fax: +39 08 05 59 28 82

Email: mario.testini@chirgen2.uniba.it