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J Thorac Cardiovasc Surg 2004;127:868-876
© 2004 The American Association for Thoracic Surgery

General thoracic surgery

Prognostic factors for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis

Atsushi Watanabe, MDa,*, Toshiaki Watanabe, MDa, Takuro Obama, MDa, Tohru Mawatari, MDa, Hisayoshi Ohsawa, MDa, Yasunori Ichimiya, MDa, Noriyuki Takahashi, MDa, Katsuyuki Kusajima, MDa, Tomio Abe, MDa

a Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan

Received for publication March 18, 2003; revisions received July 22, 2003; accepted for publication July 28, 2003.

* Address for reprints: Dr A. Watanabe, Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan
atsushiw{at}sapmed.ac.jp

OBJECTIVE: The purpose of this study was to assess which clinical features of patients with myasthenia gravis predict postoperative respiratory problems due to myasthenic crisis after transsternal thymectomy.

METHODS: One hundred twenty-two patients who underwent transsternal thymectomy in our institute were analyzed retrospectively. Fourteen of those experienced myasthenic crisis and required prolonged (48 hours or more) postoperative mechanical ventilation. The following factors were evaluated: sex, age, body mass index, grade of symptom, disease interval, existence of thymoma, history of preoperative crisis, doses of anticholinesterase drugs, steroid use, pulmonary function, serum anti-acetylcholine receptor antibody, history of pulmonary disease, presence of other disease, operation time, and blood loss.

RESULTS: Univariate analysis revealed preoperative bulbar symptoms (odds ratio = 14.246, P = .001), history of preoperative myasthenic crisis (7.091, .018), and preoperative serum level of anti-acetylcholine receptor antibody > 100 nmol/L (4.098, .044) were prognostic factors for postoperative myasthenic crisis. On the other hand, multivariate logistic regression analysis revealed preoperative bulbar symptoms (33.333, .004), preoperative serum level of anti-acetylcholine receptor antibody > 100 nmol/L (7.874, .020), and intraoperative blood loss > 1000 mL (18.519, .048) were prognostic factors for postoperative myasthenic crisis.

CONCLUSIONS: In this study, postoperative myasthenic crisis after transsternal thymectomy in 122 patients with myasthenia gravis was affected by the existence of preoperative bulbar symptoms, history of preoperative myasthenic crisis, preoperative serum level of anti-acetylcholine receptor antibody > 100 nmol/L, and intraoperative blood loss > 1000 mL. Meticulous preoperative and postoperative care should be carried out to prevent postoperative myasthenic crisis in patients with these prognostic factors.




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