In: COPD25 Apr 2014
COPD is a term used to describe a condition in which there is impaired pulmonary function because of long-standing deterioration in the respiratory elements involved with gas exchange. Traditionally, arterial blood gas (ABG) analysis and pulmonary function testing have been used to define the presence and severity of COPD. However, because of the broad spectrum of the disease, a precise definition is difficult to assign. Depending on whether the condition is mild or severe, the results of ABGs and pulmonary function tests can vary. As such, a clinical-based definition has become an alternative means of assigning a COPD diagnosis. Patients with long-standing smoking histories coupled with progressive noncardiac dyspnea requiring intervention with β-agonist inhalers and steroids have been considered to have COPD. The Summit Database, a national service with >700,000 cases in 750 hospitals with 1,750 participating surgeons, records the outcome of cardiac surgical procedures and defines COPD as follows: requires therapy for the treatment of chronic pulmonary compromise or has an FEVj^ <75% of predicted value.
The impact of COPD in patients undergoing general surgery and thoracic surgery is well known. The influence of COPD in patients undergoing open heart surgery is problematic because of the additional influence of cardiopulmonary bypass (CPB). At one time, significant pulmonary disease was considered a contraindication to open heart surgery. As a result of improvements in cardiac anesthesia, advances in the techniques of CPB, and progress in critical care management, cardiac surgery in patients with COPD has become acceptable and more common. The purpose of this article is to more fully define the outcome of coronary artery bypass grafting (CABG) in patients with COPD.
Materials and Methods
From March 1, 1995, through June 21, 1996, 1,929 patients underwent CABG at Allegheny University Hospital, Hahnemann Division, Philadelphia. One hundred ninety-one patients (11%) had COPD, which was defined according to the Summit Database definition: requires therapy for the treatment of chronic pulmonary compromise or has an FEVL <75% of predicted value. There were 129 male and 62 female patients. The mean age was 69 years (45 to 86 years).
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