CHRONIC OBSTRUCTIVE PULMONARY-DISEASE IN PATIENTS UNDERGOING CORONARY-ARTERY BYPASS-GRAFTING

The purpose of this study was to evaluate the effect of chronic obstru ctive pulmonary disease on patients undergoing coronary artery bypass grafting. Between June 1991 and June 1993, 651 patients underwent coro nary artery bypass grafting: 37 patients (group I) had significant chr onic obstructive pulmonary disease. These patients were compared with 37 matched control subjects (group II). Comparison of the groups was m ade with regard to postoperative morbidity and mortality. Quality of l ife of survivors was compared at the last follow-up. More patients in group I had preoperative arrhythmias (8 versus 1,p = 0.014). Group I p atients had lower values of forced expiratory volume in 1 second (1.36 6 +/- 0.032 L versus 2.335 +/- 0.49 L, p < 0.0001), lower oxygen tensi on (63.5 +/- 8.2 versus 79.1 +/- 13.4 mm Hg, p = 0.001), and higher ca rbon dioxide tension (44.8 +/- 6.5 mm Hg versus 39.7 +/- 3.6 mm Hg, p 0.001). After operation patients in group I had a longer hospital stay (8.1 +/- 3.6 days versus 6.6 +/- 1.7 days, p = 0.0236) and longer int ensive care unit stay (2.64 +/- 0.9 days versus 1.23 +/- 0.49 days, p = 0.0001). More patients in group I required prolonged intubation (7 v ersus 1, p = 0.0278) and reintubation (5 versus 1, p = 0.088). More pa tients in group I had significant arrhythmias (27 versus 9, p < 0.0001 ). During a 16-month follow-up period, five patients in group I died, whereas none in group II: died (p = 0.0271). Four deaths were related to arrhythmias. More group I patients were not functionally improved b y the operation (17 versus 3,p 0.0056). The results of coronary artery bypass grafting in patients with significant chronic obstructive pulm onary disease were not favorable in midterm follow-up. A major cause f or morbidity and mortality was postoperative arrhythmias.