Original article
Cardiovascular
Influence of Pleurotomy on Pulmonary Function After Off-Pump Coronary Artery Bypass Grafting

https://doi.org/10.1016/j.athoracsur.2007.04.062Get rights and content

Background

This study evaluated the influence of pleurotomy on pulmonary function after off-pump coronary artery bypass grafting (CABG) using the left internal thoracic artery (LITA).

Methods

Thirty patients were prospectively allocated into two groups: 15 patients with an opened left pleural cavity (OP group) and 15 patients with an intact pleural cavity (IP group). Bedside pulmonary function tests were recorded preoperatively and on postoperative days 1, 3, and 5. Arterial blood gas analyses and ratio of partial pressure of arterial oxygen (Pao2)/fraction of inspired oxygen (Fio2) ratio were evaluated preoperatively and on postoperative day 1.

Results

A significant decrease of pulmonary function was observed in both groups until postoperative day 5. When compared with the percentage of the preoperative value, the forced vital capacity was significantly lower in the OP group than in the IP group on postoperative days 1 (33.3% ± 8.3% versus 49.1% ± 8.4%, p < 0.001), 3 (45.4% ± 7.0% versus 62.1% ± 8.6%, p < 0.001), and 5 (56.1% ± 8.7% versus 77.5% ± 11.6%, p < 0.001). Similar results were found for forced expiratory volume in 1 second on postoperative days 1 (35.7% ± 8.6% versus 50.0% ± 9.8%, p < 0.001), 3 (48.4% ± 7.0% versus 61.5% ± 9.02%, p < 0.001) and 5 (58.8% ± 8.5% versus 75.9% ± 10.2%, p < 0.001). The Pao2 value and the Pao2/Fio2 ratio dropped on postoperative day 1 in both groups (p < 0.05), with a higher fall in the OP group (p < 0.05). Orotracheal intubation time (p = 0.012) and hospital stay (p = 0.002) were lower in the IP group.

Conclusions

Off-pump CABG using the LITA, independently of pleural opening, induced a significant reduction in early postoperative pulmonary function. However, the patients undergoing pleurotomy demonstrated more pronounced pulmonary dysfunction.

Section snippets

Patients and Methods

This study was performed in the Pirajussara and Sao Paulo Hospitals of the Federal University of Sao Paulo, Sao Paulo, Brazil. The Institutional Ethics Committee for Clinical Research approved the protocol, and written informed consent was obtained from all participants of the study.

Results

Preoperative and intraoperative patient characteristics are summarized in Table 1. No statistical difference was found in terms of age, gender, body mass index (BMI), preoperative pulmonary function, operative time, and number of grafts per patient.

A significant decrease in pulmonary function tests was observed in both groups until POD 5 (p < 0.05). The FVC mean, expressed as a percentage of the preoperative value, was significantly lower in the OP group than in the IP group on PODs 1 (33.3% ±

Comment

The present study demonstrates that an evident impairment of pulmonary function occurs in the early postoperative period of off-pump CABG independent of the pleurotomy, an effect already reported by other authors studying the same subject in on-pump CABG [3, 4, 5, 6, 17, 18]. The cause of the significant reduction on pulmonary function after CABG surgery is multifactorial [10]:

  • The general anesthesia results in reduction of the diaphragmatic tonus with an upward shift, relaxation of the chest

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