Different CABG methods in patients with chronic obstructive pulmonary disease

Background. Pulmonary dysfunction is still a major problem in coronary arte ry bypass grafting (CABG). The purpose of this randomized study was to dete rmine the effect of different CABG techniques on pulmonary function. Methods. Fifty eight patients with severe obstructive pulmonary disease had elective isolated coronary surgery. The surgical methods for the patients with chronic obstructive pulmonary disease (COPD) were standard CABG in 18 patients (group 1), beating heart surgery in 19 patients (group 2), and min imally invasive direct coronary artery bypass grafting (MIDCABG) in 21 pati ents (group 3). Results. The earliest extubation time was from group 3 (p < 0.001). The ave rage stay in the intensive care unit was significantly longer in group 1 (2 .6 +/- 1.5 days) than in groups 2 (1.4 +/- 0.8 days) and 3 (1.1 +/- 0.8 day s) (p < 0.05). The most prevalent respiratory morbidity was atelectasis tha t developed in 6 patients from group 1, in 2 patients from group 2, and in 3 patients from group 3. Forced expiratory volumes in 1 second (FEV,) obtai ned in the second postoperative month were significantly lower than preoper ative values only in group 1 (p < 0.05). Forced vital capacity (FVC) values were significantly lower than the preoperative values in all three groups (p < 0.05). Conclusions. Off-pump bypass surgical procedures are more advantageous than on-pump methods for patients with COPD. These patients can be operated on using the beating heart technique or by using MIDCABG to prevent side effec ts of CPB on pulmonary function and effects of sternotomy. (Ann Thorac Surg 2001;71:152-7) (C) 2001 by The Society of Thoracic Surgeons.