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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 6, November/December 2014
AFRICA
279
Is chronic obstructive pulmonary disease a risk factor
for epistaxis after coronary artery bypass graft surgery?
Faruk Cingoz, Bilgehan Savas Oz, Gokhan Arslan, Adem Guler, Mehmet Ali Sahin, Celalettin Gunay,
Mehmet Arslan
Abstract
Background:
Chronic obstructive pulmonary disease (COPD)
has customarily been associated with increased surgical
morbidity and mortality rates after coronary artery bypass
graft surgery (CABG). The aim of this study was to deter-
mine whether there is a relationship between epistaxis and
COPD after CABG surgery.
Methods:
There were 3 443 patients who consecutively under-
went isolated CABG from January 2002 to March 2012. We
retrospectively analysed the data of 27 patients (0.8%) with
newly developed and serious spontaneous epistaxis, which
required consultation with the Ear Nose and Throat (ENT)
Department. The patients were divided into three groups
according to severity of nasal bleeding. Twenty-one (77.7%)
patients in the three groups had COPD.
Results:
There were 19 males (70%) and eight females (30%).
Their ages ranged between 52 and 72 years (mean 61
±
5).
Fifty-five per cent of the patients had hypertension and 78%
had COPD. The overall duration of hospital stay was six to 11
days (mean 7.9
±
1.1). Epistaxis was seen particularly on the
fourth and seventh days postoperatively and 17 patients (63%)
were treated with anterior, posterior, or anterior and posterior
nasal packing (group 1). Nasal bleeding was controlled with
electrocautery in six patients (22%) (group 2), and four (15%)
were treated with surgical excision and blood transfusions
(group 3). All patients (100%) had a good recovery with no
mortality.
Conclusion:
The high coincidence between epistaxis and
COPD made us wonder whether COPD may be a risk factor
for epistaxis after CABG surgery. However, we could not
find any direct causative link between COPD and epistaxis
in patients who had undergone CABG. Epistaxis was more
common in patients with COPD and it was more serious
clinically in patients who had both COPD and hypertension.
Keywords:
epistaxis, chronic obstructive pulmonary disease,
coronary artery bypass surgery
Submitted 14/11/13, accepted 10/10/14
Published online 10/11/14
Cardiovasc J Afr
2014;
25
: 279–284
www.cvja.co.zaDOI: 10.5830/CVJA-2014-061
Epistaxis is the most common otolaryngological emergency that
affects up to 60% of the population in their lifetime. Six per cent
of all epistaxis cases require medical attention.
1
Chronic obstructive pulmonary disease (COPD) is
often considered a risk factor for postoperative morbidity
and mortality after coronary artery bypass graft (CABG)
surgery. Postoperative complications such as respiratory
failure, re-intubation, sternal dehiscence, prolonged mechanical
ventilation, rhythm disturbances and prolonged hospital stays
are known complications of COPD in CABG patients.
2
Epistaxis is a rare complication that is not directly related to
heart surgery.
3
Many factors affect bleeding after cardiac surgery,
such as thrombolytic agents, hypertension, trauma and nasal
oxygen therapy. Data on the association between epistaxis and
CABG surgery is less clear.
4
There is a paucity of published data
regarding the management of epistaxis in patients with COPD
who undergo CABG. We conducted this study to determine
whether there was a relationship between epistaxis and COPD
after CABG surgery.
Methods
This was a retrospective study. All patients of any age who
consulted at the Ear Nose and Throat (ENT) Department with
a diagnosis of serious spontaneous epistaxis requiring at least
one nasal pack after CABG surgery were included in the study.
Patients were divided into three groups according to the severity
of nasal bleeding, which was determined by treatment modality.
The three procedures included packing (anterior, posterior or
anterior-posterior) (group 1), treatment with electrocautery
(under direct vision or via endoscopic guidance) (group 2) and
surgical ligation of bleeding vessels (group 3).
The 3 443 patients who underwent isolated CABG from 2002
to 2012 were assessed in this study and follow up was obtained
from a review of their charts. We focused on only objective data
obtained from the medical records, and analysed a total of 27
(0.8%) patients with complete data who consulted at the ENT
Department with a diagnosis of spontaneous and incipient
epistaxis (Tables 1–3).
All patients were operated on via a median sternotomy, with
standard cardiopulmonary bypass procedure and moderate
hypothermia. Myocardial preservation was accomplished with
intermittent antegrade delivery of St Thomas II solution.
Cardiopulmonary bypass was initiated after anticoagulation with
bovine lung heparin. The heparin was reversed by protamine at
Department of Cardiovascular Surgery, Gulhane Military
Medical Academy, Etlik, Ankara, Turkey
Faruk Cingoz, MD,
fcingoz@yahoo.comBilgehan Savas Oz, MD
Gokhan Arslan, MD
Adem Guler, MD
Mehmet Ali Sahin, MD
Celalettin Gunay, MD
Mehmet Arslan, MD