Coronary Artery Bypass Grafting in Patients With COPD

doi:10.1378/chest.113.4.878

Chest

Volume 113, Issue 4, April 1998, Pages 878-882

https://doi.org/10.1378/chest.113.4.878 Get rights and content

Objective

To more fully define the influence of COPD in patients undergoing coronary artery bypass grafting (CABG).

Methods

One hundred ninety-one patients with COPD underwent CABG from March 1, 1995, to June 21, 1996. There were 129 male and 62 female patients. The mean age was 69 years (45 to 86 years). Patients with COPD were defined according to the Summit Database definition: requires therapy for the treatment of chronic pulmonary compromise or has an FEV₁ <75% of predicted value.

Results

Hospital mortality was 7%. Hospital morbidity was 50%. Statistically significant (p<0.05) morbidity included general pulmonary complications (12%) and atrial fibrillation (27%). Hospital mortality for COPD patients with postoperative pneumonia was 11%. Hospital mortality for patients with COPD receiving steroids was 19%. The hospital mortality for patients ≥75 years of age was 17%. The combined mortality for patients with COPD who are ≥75 years of age and receiving steroid therapy was 50%. The mean length of stay was 12 days. Late mortality was 1% at a mean of 1.5 years.

Conclusions

Hospital mortality in most patients with mild-to-moderate COPD undergoing CABG is similar to those without COPD. In the minority of patients with severe COPD who are receiving steroids and > 75 years, the hospital mortality is exceptionally high. These findings support CABG in patients with mild-to-moderate COPD. Nonsurgical therapy should be considered for elderly COPD patients with severe disease taking steroids.

Section snippets

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 FEV₁ <75% of predicted value. There were 129 male and 62 female patients. The mean age was 69 years (45 to 86 years).

CPB was conducted with standard cannulation, moderate

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

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 1963.¹ Since the first successful application of a pump oxygenator,²

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Citation Excerpt :
Pulmonary dysfunction in patients with CLD is a well-documented risk factor for morbidity and mortality after cardiac surgery. Analyses of large cardiac registries have reported increased odds of in-hospital mortality by ratios of 1.4 to 1.6 among patients with versus without CLD.22-26 Reduction of lung function postoperatively is influenced not only by use of extracorporeal circulation but also by length of the sternal incision.13,22,23
In patients with pulmonary dysfunction, it is unclear whether a less-invasive approach for aortic valve replacement is well tolerated or even beneficial. We investigated whether a partial upper J-incision for aortic valve replacement leads to more favorable outcomes than a full sternotomy in patients with chronic lung disease by using forced expiratory volume in 1 second as a surrogate.
From January 1995 to July 2010, 6931 patients underwent primary isolated aortic valve replacement; 655 had forced expiratory volume in 1 second measured and expressed as percent of predicted (FEV1%; 368 via J-incision, 287 via full sternotomy). Postoperative outcomes were compared among 223 propensity-matched pairs.
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Chest

Clinical Investigations: SurgeryCoronary Artery Bypass Grafting in Patients With COPD

Objective

Methods

Results

Conclusions

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

Med Clin North Am

Chest

Chest

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Am Coll Cardiol

Chest

Ann Thorac Surg

Ann Thorac Surg

Clinical Investigations: Surgery
Coronary Artery Bypass Grafting in Patients With COPD