Coronary Artery Bypass Grafting in Patients With COPD: Results

In: COPD

29 Apr 2014

Coronary Artery Bypass Grafting in Patients With COPD: ResultsUsing the comparison of proportions test, a comparative analysis of CABG in 191 patients with and 1,738 patients without COPD was performed. Morbidities were significantly higher in patients with COPD (50%). The occurrence of general pulmonary complications (12%), incidence of atrial fibrillation (27%), incidence of prolonged ventilation (7%), and the occurrence of pneumonia (4%) were higher in patients with COPD. The mean length of stay was higher in patients with COPD (12 days) (Table 2).
Discussion
The influence of COPD on the results of open heart surgery is variable depending on the severity of the preoperative pulmonary dysfunction, overall condition of the patient, and the resources available to manage high-risk cases. Indeed, the impact of severe lung disease in patients undergoing cardiac surgery has been well described such that it was considered a relative contraindication to surgery for coronary artery disease in 1963. Since the first successful application of a pump oxygenator, the deleterious effects of CPB on pulmonary function have been appreciated. The term “pump lung” was used to describe a form of respiratory distress syndrome following open heart surgery with extracorporeal circulation. In 1964, Kirklin reviewed the pulmonary dysfunction after open heart surgery and remarked that patients who came to surgery with abnormal lungs would be likely to develop significant respiratory problems postoperatively. Thus, for more than 3 decades, it has been well known that the relationship of COPD and open heart surgery was a potentially dangerous one. Nevertheless, cardiac surgeons have been confronted with the challenge of managing this population, and doing so in an environment that demands cost containment, efficiency, and favorable outcomes. In our experience, and from a review of other studies, a more complete understanding of the problem of open heart surgery in patients with COPD is possible, and strategies to improve results are available. In general, the knowledge base can be divided into preoperative5 intraoperative, and postoperative categories.

Table 2—Comparison of COPD and Non-COPD Patients: Outcome

Patients Without COPD (%)* 1,738 patients Mean age = 65 yr Patients With COPD (%)* 191 patients Mean age=67 yr p Value
Complications
Hospital mortality 4 13 <0.05
Morbidity 35 50 <0.05
Pulmonary(general) 6 15 <0.05
Prolongedventilation 3 7 <0.05
Pneumonia 2 4 <0.05
Transient stroke 0.35 0.53 >0.05
Permanent stroke 3 4 >0.05
Atrial fibrillation 21 27 <0.05
Renal (general) 7 8 >0.05
Infectious(general) 4 11 >0.05
Neurologic(general) 6 7 >0.05
LOS,f d 10 12 <0.05

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