PHRENIC-NERVE INJURY AFTER CORONARY-ARTERY GRAFTING - IS IT ALWAYS BENIGN

Background. The purpose of this study was to evaluate the effect of ph renic nerve injury (PNI) occurring during coronary artery bypass graft ing in patients with major chronic obstructive pulmonary disease (COPD ). Methods. Ever a 42-month period, 1,303 patients underwent primary c oronary artery bypass grafting. Sixty-seven (5.14%) had major COPD, an d 29 (43.3%) of these 67 sustained PNI (group I). These patients were matched for age and ejection fraction with 29 CABG patients with COPD but without PNI (group II), 29 patients without COPD but with PNI (gro up III), and 29 patients with neither COPD nor PNI (group IV). The gro ups were compared on the basis of preoperative and operative factors a nd immediate and midterm morbidity and mortality. Results. There were no significant differences between the groups with respect to hyperten sion, diabetes, ejection fraction, number of grafts, internal mammary artery use, cardiopulmonary bypass time, and ischemic time. Postoperat ively, group I had a longer total hospitalization (group I, 11.7 days; group II, 7.8 days; group III, 7.8 days; and group IV, 6 days; p = 0. 0001) and stay in the intensive care unit (I, 3.6 days; II, 2.2 days; III, 2.1 days; and IV, 1.2 days; p = 0.0023). More patients in group I required reintubation (I, 37.9%; II, 3.4%; III, 6.9%; and IV, 0%; p < 0.0001). Mean follow-up was 32.8 months (range, 7 to as months). Grou p I had more hospital readmissions (I, 78; II, 50; III, 61; and IV, 28 ; p < 0.007) and lower cumulative survival (I, 60.6%; II, 93%; III, 96 .8%; and IV, 100%; p < 0.0015) compared with the other groups. Conclus ions. In patients with COPD, PNI during coronary artery bypass graftin g has a major negative impact on immediate and midterm results. (C) 19 97 by The Society of Thoracic Surgeons.