Impact of chronic obstructive pulmonary disease severity on surgical outcomes in patients undergoing non-emergent coronary artery bypass grafting

Saleh, Hesham Zayed; Mohan, Kamlesh; Shaw, Matthew; Al-Rawi, Omar; Elsayed, Hany; Walshaw, Martin; Chalmers, John; Fabri, Brian M.

doi:10.1093/ejcts/ezr271

Cited by 75 publications

(54 citation statements)

References 23 publications

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“…This study was approved by the Ethics Committee of our hospital and written informed consent was obtained from all participants. Inclusion and exclusion criteria: The patients were enrolled according to the following criteria: 1) they were diagnosed with disease in the left anterior descending artery, circumflex artery or right coronary artery using coronary angiography and in NYHA (New York Heart Association) class IV according to the NYHA functional classification system; 23) 2) Invasive coronary angiography showed severe luminal stenosis > 75%; 3) prolonged mechanical ventilation (which was defined as a requirement over 72 hours of mechanical ventilation 18,24) ) was required; 4) they had stable oxygen saturation, fraction of inspired oxygen ≤ 55%, and positive end expiratory pressure ≤ 8 cm H 2 O; 5) they received dopamine at a dose of < 10 μg/kg/ minute and epinephrine at a dose of < 0.4 μg/kg/minute; 6) they had mean arterial pressure > 70 mmHg and urine output > 1 mL/kg/hour; 7) good postoperative wound healing was obtained; 8) there was no history of chronic mental illness; and 9) they had normal cognitive function.…”

Section: Methodsmentioning

confidence: 99%

Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery

Dong

Zhang

et al. 2016

Int. Heart J.

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SummaryWe investigated the effects of early rehabilitation therapy on prolonged mechanically ventilated patients after coronary artery bypass surgery (CABG).A total of 106 patients who underwent CABG between June 2012 and May 2015 were enrolled and randomly assigned into an early rehabilitation group (53 cases) and a control group (53 cases). The rehabilitation therapy consisted of 6 steps including head up, transferring from supination to sitting, sitting on the edge of bed, sitting in a chair, transferring from sitting to standing, and walking along a bed. The patients received rehabilitation therapy in the intensive care unit (ICU) after CABG in the early rehabilitation group. The control group patients received rehabilitation therapy after leaving the ICU.The results showed that the early rehabilitation therapy could significantly decrease the duration of mechanical ventilation (early rehabilitation group: 8.1 ± 3.3 days; control group: 13.9 ± 4.1 days, P < 0.01), hospital stay (early rehabilitation group: 22.0 ± 3.8 days; control group: 29.1 ± 4.6 days, P < 0.01), and ICU stay (early rehabilitation group: 11.7 ± 3.2 days; control group: 18.3 ± 4.2 days, P < 0.01) for patients requiring more than 72 hours prolonged mechanical ventilation. The results of Kaplan-Meier analysis showed that the proportions of patients remaining on mechanical ventilation in the early rehabilitation group were larger than that in the control group after 7 days of rehabilitation therapy (logrank test: P < 0.01).The results provide evidence for supporting the application of early rehabilitation therapy in patients requiring prolonged mechanical ventilation after CABG. (Int Heart J 2016; 57: 241-246) Key words: Postoperative recovery, Hospital stay, Randomized controlled trial, Intensive care unit C oronary artery disease is the primary cause of death worldwide. 1) Coronary artery bypass surgery (CABG) is commonly used for patients with severe coronary artery disease at the left anterior descending artery, circumflex artery, and right coronary artery.2,3) Cardiac rehabilitation is used for improving functional capacity and reducing cardiovascular mortality and morbidity in patients undergoing CABG. [4][5][6] Previous studies have shown that rehabilitation therapy could significantly reduce the length of hospitalization time, costs and complications, promote cardiac function recovery, and improve the quality of life in patients who underwent CABG. [7][8][9][10][11] Mechanical ventilation was routinely applied after CABG to reduce the power consumption of the respiratory system and the cardiac burden to improve postoperative cardiac recovery. [12][13][14] Due to a system of risk factors (such as the duration of surgery, anesthesia, clinical condition, mode of ventilator therapy, and method of weaning from mechanical ventilation), many patients should receive prolonged mechanical ventilation. [15][16][17] It was reported that the prolonged mechanical ventilation could prolong the hospital and intensive care unit (ICU) stay, 18) incre...

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Section: Methodsmentioning

confidence: 99%

Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery

Dong

Zhang

et al. 2016

Int. Heart J.

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“…There are many studies that investigate the relationship between severity of COPD and cardiovascular diseases. It was demonstrated that FEV1 was associated with early mortality following CABG [5]. In a large population-based study over an average follow-up of 14.9 years, low FEV1 was found to be associated with incident heart failure [6].…”

Section: Discussionmentioning

confidence: 99%

“…Chronic obstructive pulmonary disease is associated with increased mortality in patients with CAD undergoing PCI or CABG [4,5]. It has also been reported that COPD is strongly associated with the risk of incident heart failure [6].…”

Section: Introductionmentioning

confidence: 99%

Forced expiratory volume in one second can predict SYNTAX score in patients with chronic obstructive pulmonary disease

Köseoğlu

Kurmuş

Ertem³

et al. 2016

Kardiol Pol

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A b s t r a c t Background:The SYNTAX score is an angiographic score that predicts coronary artery disease (CAD) complexity. It has been shown to be useful for decision making about percutaneous coronary intervention or coronary artery bypass grafting among patients with CAD. Higher SYNTAX scores are indicative of more complex disease. Chronic obstructive pulmonary disease (COPD) is characterised by limitation of airflow. Measurement of forced expiratory volume in one second (FEV1) in spirometry is used for diagnosis and to determine the severity of the disease.Aim: To evaluate the relationship between FEV1 and SYNTAX score in patients with COPD.Methods: Seventy-eight patients with a previous diagnosis of COPD and 48 patients without COPD were enrolled. Spirometry and coronary angiography were performed in all patients. SYNTAX score was calculated and compared between the two groups. The correlation between FEV1 and SYNTAX score was analysed.Results: SYNTAX score was higher in patients with COPD than in patients without COPD (23.22 ± 12.10 vs. 17.92 ± 11.21, respectively; p = 0.013). Multivariate analysis demonstrated that COPD was independently predictive for intermediate and high SYNTAX score (odds ratio 4.833; 95% confidence interval 2.228-10.485; p < 0.001). Mean FEV1 (% predicted) was 64.7 ± 11.4 and negatively correlated with SYNTAX score in COPD group (r = -0.266 and p = 0.018). The receiver operating characteristic analysis yielded a cutoff value of 65.5 for the FEV1 to predict SYNTAX score ≥ 23, with sensitivity and specificity being 78.6% and 70%, respectively. Conclusions:COPD is a predictor of higher SYNTAX scores. FEV1 is associated with more severe and complex CAD.

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“…In summary, the intervention bore a significant risk, but the patient strongly wished it which was justified from his point of view as well as from the literature [6,7].…”

Section: Probabilitymentioning

confidence: 97%

“…The patient was clearly aware of his critical and difficult situation. He knew that his COPD worsened his chance for a favorable perioperative outcome [7]. This made him uneasy and sad, but after medical treatment of insomnia and depressive mood, he seemed to have a positive attitude towards his future and hoped to spend some more good years.…”

Section: Probabilitymentioning

confidence: 99%

When is an invasive palliative intervention in an acute internal medical patient worth it? A structured palliative approach

Weber¹,

Strasser

2015

Wien Med Wochenschr

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A 67-year-old patient with coronary artery disease (CAD), diabetes, and chronic obstructive pulmonary disease (COPD) was scheduled for coronary artery bypass graft (CABG) surgery after a recent myocardial infarction despite a high perioperative risk of death. While waiting, acute renal failure developed, and the patient was admitted to the intensive care unit (ICU). After the patient and his wife were informed that CABG surgery was no longer possible, he declined further intensive care treatment and subsequently died peacefully.We show that a structured palliative approach which has been proposed for cancer patients may also be feasible in palliative situations concerning nononcologic patients.

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Impact of chronic obstructive pulmonary disease severity on surgical outcomes in patients undergoing non-emergent coronary artery bypass grafting

Abstract: The severity of COPD as defined by spirometry can be a prognostic marker in patients undergoing CABG. Spirometric criteria may help refining currently used operative risk scores.

Cited by 75 publications

References 23 publications

Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery

Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery

Forced expiratory volume in one second can predict SYNTAX score in patients with chronic obstructive pulmonary disease

When is an invasive palliative intervention in an acute internal medical patient worth it? A structured palliative approach

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