CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
184
AFRICA
Pre-treatment before coronary artery bypass surgery
improves post-operative outcomes in moderate chronic
obstructive pulmonary disease patients
BILGEHAN SAVAS OZ, ERKAN KAYA, GOKHAN ARSLAN, KUBILAY KARABACAK, FARUK CINGOZ,
MEHMET ARSLAN
Abstract
Introduction:
Chronic obstructive pulmonary disease
(COPD) has traditionally been recognised as a predictor
of poorer early outcomes in patients undergoing coronary
artery bypass grafting (CABG). The aim of this study was to
analyse the impact of different COPD stages, as defined by
the Global Initiative for Chronic Obstructive Lung Disease
(GOLD) spirometric criteria, on the early surgical outcomes
in patients undergoing primary isolated non-emergency
CABG
Methods:
Between January 2008 and April 2012, 1 737
consecutive patients underwent isolated CABG in the
Department of Cardiovascular Surgery of Gulhane Military
Academy of Medicine; 127 patients with the diagnosis of
moderate-risk COPD were operated on. Only 104 patients
with available pulmonary function tests and no missing data
were included in the study. Two different treatment protocols
had been used before and after 2010. Before 2010, no treat-
ment was applied to patients with moderate COPD before
the CABG procedure. After 2010, a pre-treatment protocol
was initiated. Patients who had undergone surgery between
2008 and 2010 were placed in group 1 (no pre-treatment,
n
=
51) and patients who had undergone surgery between
2010 and 2012 comprised group 2 (pre-treatment group,
n
=
53). These two groups were compared according to the post-
operative morbidity and mortality rates retrospectively, from
medical reports.
Results:
The mean ages of the patients in both groups were
62.1
±
7.6 and 64.5
±
6.4 years, respectively. Thirty-nine of
the patients in group 1 and 38 in group 2 were male. There
were similar numbers of risk factors such as diabetes, hyper-
tension, renal disease (two patients in each group), previous
stroke and myocardial infarction in both groups. The mean
ejection fractions of the patients were 53.3
±
11.5% and 50.2
±
10.8%, respectively. Mean EuroSCOREs of the patients
were 5.5
±
2.3 and 5.9
±
2.5, respectively in the groups. The
average numbers of the grafts were 3.1
±
1.0 and 2.9
±
0.9.
Mean extubation times were 8.52
±
1.3 hours in group 1
and 6.34
±
1.0 hours in group 2. The numbers of patients
who needed pharmacological inotropic support were 12 in
group 1 and five in group 2. Duration of hospital stay of the
patients was shorter in group 2.While there were 14 patients
with post-operative atrial fibrillation (PAF) in group 1, the
number of patients with PAF in group 2 was five. Whereas
there were seven patients who had pleural effusions requir-
ing drainage in group 1, there were only two in group 2.
There were three mortalities in group 1, and one in group 2.
There were no sternal infections and sternal dehiscences in
either group.
Conclusion:
Pre-treatment in moderate-risk COPD patients
improved post-operative outcomes while decreasing adverse
events and complications. Therefore for patients undergoing
elective CABG, we recommend the use of medical treatment.
Keywords:
cardiac surgery, complication, EuroSCORE, morbid-
ity, risk factors
Submitted 1/11/12, accepted 10/5/13
Cardiovasc J Afr
2013;
24
: 184–187
DOI: 10.5830/CVJA-2013-034
Chronic obstructive pulmonary disease (COPD) is one of the
leading causes of chronic morbidity and death in the world and
it has traditionally been recognised as a predictor of poorer early
outcomes in patients undergoing coronary artery bypass grafting
(CABG).
1,2
The EuroSCORE system also includes chronic lung
disease as an independent predictor of operative mortality,
although with a generic definition not necessarily reflecting
disease severity.
3
By contrast, some recent studies deny the
association between COPD and increased early morbidity and
mortality risk after CABG. Given the heterogeneity of clinical
and/or spirometric variables used to define COPD by these
different authors,
2
and the continuous emphasis recent guidelines
place on the importance of spirometry as the gold standard for
the diagnosis and staging of severity in COPD patients (GOLD
guidelines update available at
),
4
further
investigation on this topic was deemed necessary.
Post-operative complications such as respiratory failure,
prolonged intubation time, intensive care unit (ICU) and hospital
stay, sternal dehiscence and post-operative rhythm disturbances
(mainly atrial fibrillation) are common in COPD patients.
1
Standard median sternotomy and cardiopulmonary bypass (CPB)
have negative effects on pulmonary function. Pleurotomy during
the harvesting of the left internal thoracic artery (LITA) and pain
(due to chest tubes and incisions) may also negatively affect the
patient’s lung capacity. Patients with moderate COPD already
have limited lung capacity and these patients may be severely
affected by the effects of both CPB and the surgical trauma.
5
The purpose of this study was to analyse the impact of
pre-treatment in moderate COPD patients, as defined by the
Gulhane Military Medical Academy, Cardiovascular Surgery
Department, Etlik, Ankara, Turkey
BILGEHAN SAVAS OZ, MD,
ERKAN KAYA, MD
GOKHAN ARSLAN, MD
KUBILAY KARABACAK, MD
FARUK CINGOZ, MD
MEHMET ARSLAN, MD
