Coronary Artery Bypass Grafting in Patients With COPD: Materials and Methods

In: COPD

27 Apr 2014

CPB was conducted with standard cannulation, moderate hypothermia, and antegrade/retrograde cardioplegia. A roller head pump and hollow fiber membrane oxygenator were employed. Bypass conduits consisted of saphenous vein grafts and internal thoracic arteries (ITAs). The presence of COPD did not influence the use of the left ITA.
The hospital course and outcome for COPD patients were retrospectively compared with non-COPD counterparts. A comparison of proportions test was utilized to determine statistical significance of data. Follow-up of 100% of the patients was completed through telephone interviews with patients or family members.
Results
The medical records of 191 consecutive patients with COPD undergoing CABG from March 1, 1995, through June 21, 1996 were reviewed. Preoperative risk factors included the following: smoking in 160 (84%), angina in 156 (82%), hypertension in 132 (69%), prior myocardial infarction in 122 (64%), and family history of coronary artery disease in 73 (38%) patients. Other factors included congestive heart failure in 66 (35%) patients, diabetes in 52 (27%), hypercholesterolemia in 52 (27%), arrhythmias in 40 (21%), and morbid obesity in 21 (11%). Twenty-seven patients (14%) were receiving steroids preop-eratively. Forty-seven (25%) patients with COPD were >75 years of age. Six (13%) patients were >75 years of age and receiving steroids preoperatively (Table 1). canadian family pharmacy online

The mean number of bypasses was three (one to six bypasses). The left ITA was used in 165 (87%) cases. The mean CPB time was 109 min (35 to 228 min) and the mean aortic cross-clamp time was 68 min (17 to 180 min).
There were 13 (7%) hospital mortalities. The hospital mortality for the 47 COPD patients 75 years of age was 17%. The hospital mortality for the 27 COPD patients receiving steroids was 19%. The combined mortality for the six COPD patients 75 years of age and receiving steroids was 50% (Table 1). Morbidities were noted in 96 (50%) patients, including 23 (12%) pulmonary, 16 (8%) renal, 14 (7%) neurologic, and 13 (7%) infectious. The average length of stay was 12 days (4 to 101 days). Follow-up was complete. Six (3%) patients were readmitted to the hospital within 30 days of surgery. There was 1 (1%) late mortality at a mean follow-up of 1.5 years.

Table 1—Comparison of Outcome: Effect of Age and Steroids

Morbidity (%) p Value Mortality (%) p Value Total
COPD 95 (50) 13 (7) 191
COPD, no steroids 81 (49) >0.05 8(5) <0.05 164
COPD, steroids 14 (52) 5(19) 27
COPD, <75 yr 70 (49) >0.05 5(4) <0.05 144
COPD, >75 yr 25 (53) 8(17) 47
COPD, <75 yr, steroids 13 (62) <0.05 2(10) <0.05 21
COPD, >75 yr, steroids 1(17) 3(50) 6

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