CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
AFRICA
187
at an increased risk for lower respiratory tract infections because
of the immune-suppressing effects of CPB, combined with the
respiratory flora of these patients.
As demonstrated by Gaynes
et al
.,
12
development of
pneumonia following CABG in COPD patients was associated
with a 27% mortality rate. In the study by Fuster
et al
.,
7
18%
of their moderate-to-severe COPD patients had post-operative
pneumonia, with a mortality rate of 56%. In another study,
Manganas
et al
.
13
reported more frequent pneumonia in COPD
patients than in the control group (eight in the mild-to-moderate
COPD group and two in the severe COPD group). In our study
we had four pneumonia cases in group 1 and one in group 2.
Moreover, prolonged ventilation is known to result in
increased ICU stay. Although in their study, Manganas
et al
.
13
found no difference between their study groups for prolonged
mechanical ventilation and length of ICU stay, in our study, mean
mechanical ventilation times and length of ICU stay of patients
in group 1 were significantly longer than in patients in group 2.
Similar to our findings, in Fuster’s study,
7
incidence of prolonged
ventilation and re-intubation was higher in moderate-to-severe
COPD patients.
In a study by Bingol
et al
.,
1
the effect of prophylactic oral
prednisolone in COPD patients was assessed. As a result they
demonstrated that prophylactic treatment with prednisolone
decreased both mechanical ventilation time and length of stay in
ICU. These results were similar to our findings. From this point
of view, it can be extrapolated that pre-treatment before surgery
improves post-operative pulmonary function and shortens ICU
stay.
Supraventricular tachyarrhythmias are common after CABG
in COPD patients. In their study, Manganas reported 30% atrial
fibrillation in the mild-to-moderate COPD group and 45% in the
severe COPD group.
13
In Fuster’s study,
7
the incidence of atrial
fibrillation was lower than in the study by Manganas. The rate
was 7.6% in the moderate group and 11.4% in the severe COPD
group. In our study, there were 14 (26%) patients with atrial
fibrillation in group 1 and five (9%) in group 2. For group 1,
our results were similar to Manganas’s study. From this, it can
be concluded that the rate of atrial fibrillation was significantly
lower in the pre-treatment group.
Optimisation of management in the pre-, peri- and post-
operative periods may be the key to reducing the negative
outcomes in this high-risk group.
14
It is important to improve the
respiratory status of these patients by means of adjustment of their
bronchodilator therapy and strict control by a physiotherapist.
The correct timing of surgery is also mandatory in order to avoid
the respiratory decompensation phases.
7
In the present study,
we found that pre-treatment before surgery in moderate COPD
patients improved early post-operative outcomes and decreased
complications following CABG.
Conclusion
Pre-treatment in moderate-risk COPD patients improved post-
operative outcomes while decreasing the adverse events and
complications. We believe that in order to improve post-operative
outcomes, a holistic approach must be applied for these patients.
Not only bronchodilator treatment but also appropriate antibiotic
treatment, besides physical exercise under strict control and
perfect timing are key factors for the best results following
CABG.
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