DISORDERS OF EXTERNAL RESPIRATION AND THEIR IMPACT ON THE CLINICAL OUTCOME IN THE PATIENTS UNDERGOING CARDIAC SURGERY

Goal: to investigate the frequency and specific features of respiratory disorders and their impact on the clinical course in the patients having coronary artery bypass graft operation. Materials. 454 patients expecting coronary artery bypass graft operation were enrolled into the prospective cohort study. External respiration function was evaluated prior to the surgery. Pathologic respiration patterns were assessed basing on forced expiratory volume per 1 second (FEV1 ) and forced vital lung capacity (FVLC). The pattern was evaluated as obstructive with the ratio of FEV1 /FVLC < 0.70; and the restrictive pattern was the combination of FEV1 /FVLC≥ 0.70 and FVLC < 80% of "must". Results. Obstructive and restrictive patterns were detected in 72 (15.8%) and 50 (11.0%) patients respectively. Out of 133 patients with compromised external respiration function chronic obstructive pulmonary disease was diagnosed only in 26 patients. Bronchial obstruction was related to the risk of auricular fibrillation, increase of duration of artificial pulmonary ventilation and prolonged hospital stay. Conclusion. It has been demonstrated that it is possible to improve clinical outcomes in the patients undergoing cardiac surgery through diagnostics of respiratory disorders, detection of risk groups and prevention of complications.

1. Ponomarev D.N., Kamenskaya O.V., Klinkova А.S. et al. Impact of bronchial obstructive syndrome on the peri-operative characteristics of patients undergoing coronary artery bypass graft: intermediate results of the prospective cohort study. Patolog. Krovoobrasch. i Kardiokhirur., 2015, vol. 19, no. 4, pp. 72-78. (In Russ.)

2. Adabag A.S., Wassif H.S., Rice K. et al. Preoperative pulmonary function and mortality after cardiac surgery. Am. Heart J., 2010, no. 159, pp. 691-697.

3. Ad N., Henry L., Halpin L. et al. The use of spirometry testing prior to cardiac surgery may impact the Society of Thoracic Surgeons risk prediction score: a prospective study in a cohort of patients at high risk for chronic lung disease. J. Thorac. Cardiovasc. Surg., 2010, no. 139, pp. 686-691.

4. American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. Am. Rev. Respir. Dis., 1991, no. 144 (5), pp. 1202-1218.

5. Anthonisen N.R., Connett J.E., Enright P.L. et al. Hospitalizations and mortality in the lung health study. Am. J. Respir. Crit. Care Med., 2002, no. 166, pp. 333-339.

6. Body Plethysmography. 2001 Revision & Update. AARC Clinical Practice Guideline. Respir. Care, 2001, vol. 5, no. 46, pp. 506-513.

7. Buch P., Friberg J., Scharling H. et al. Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study. Eur. Respir. J., 2003, no. 21, pp. 1012-1016.

8. Calkins H., Kuck K.H., Cappato R. et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management

9. and follow-up, definitions, endpoints, and research trial design. Europace, 2012, no. 14, pp. 528-606.

10. Calverley P.M.A., Anderson J.A., Celli B. et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N. Engl. J. Med., 2007, no. 356, pp. 775-789.

11. Clough R.A., Leavitt B.J., Morton J.R. et al. The effect of comorbid illness on mortality outcomes in cardiac surgery. Arch. Surg., 2002, no. 137, pp. 428-433.

12. Cooper B.G. An update on contraindications for lung function testing. Thorax, 2011, no. 66, pp. 714-723.

13. Engström G., Lind P., Hedblad B. et al. Lung function and cardiovascular risk relationship with inflammation-sensitive plasma proteins. Circulation, 2002, no. 106, pp. 2555-2560.

14. Eriksson B., Lindberg A., Mullerova H. et al. Association of heart diseases with COPD and restrictive lung function – Results from a population survey. Respir. Med., 2013, no. 107, pp. 98-106.

15. Fabbri L.M., Luppi F., Beghe B. et al. Complex chronic comorbidities of COPD. Eur. Respir. J., 2008, no. 31, pp. 204-212.

16. Gan W.Q., Man S.F.P., Senthilselvan A. et al. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax, 2004, no. 59, pp. 574-580.

17. Gao D., Grunwald G.K., Rumsfeld J.S. et al. Variation in mortality risk factors with time after coronary artery bypass graft operation. Ann. Thorac. Surg., 2003, no. 75, pp. 74-81.

18. Gracey D.R., Divertie M.B., Didier E.P. Preoperative pulmonary preparation of patients with chronic obstructive pulmonary disease: a prospective study. Chest, 1979, no. 76, pp. 123-129.

19. Hawkins N.M., Virani S., Ceconi C. Heart failure and chronic obstructive pulmonary disease: the challenges facing physicians and health services. Eur. Heart J., 2013, no. 34, pp. 2795-2803.

20. Johnson R.L.J. Gas exchange efficiency in congestive heart failure. Circulation, 2000, vol. 24, no. 101, pp. 2774-2776.

21. Johnson R.L.J. Gas exchange efficiency in congestive heart failure II. Circulation, 2001, vol. 7, no. 103, pp. 916-918.

22. Jones P.W., Harding G., Berry P. et al. Development and first validation of the COPD Assessment Test. Eur. Respir. J., 2009, no. 34, pp. 648-654.

23. Kang H., Bae B.S., Kim J.H. et al. The relationship between chronic atrial fibrillation and reduced pulmonary function in cases of preserved left ventricular systolic function. Korean Circ. J., 2009, no. 39, pp. 372-377.

24. Kuralay E., Cingöz F., Kiliç S. et al. Supraventricular tachyarrythmia prophylaxis after coronary artery surgery in chronic obstructive pulmonary disease patients (early amiodarone prophylaxis trial). Eur. J. Cardiothorac. Surg., 2004, no. 25, pp. 224-230.

25. Leavitt B.J., Ross C.S., Spence B. et al. Long-term survival of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass surgery. Circulation, 2006, no. 114, pp. 430-435.

26. Légaré J.F., Hirsch G.M., Buth K.J. et al. Preoperative prediction of prolonged mechanical ventilation following coronary artery bypass grafting. Eur. J. Car-diothorac. Surg., 2001, no. 20, pp. 930-936.

27. Levey A.S., Stevens L.A., Schmid C.H. et al. A new equation to estimate glomerular filtration rate. Ann. Intern. Medt., 2009, no. 150, pp. 604-612.

28. Lomivorotov V.V., Efremov S.M., Pokushalov E.A. et al. New-onset atrial fibrillation after cardiac surgery: pathophysiology, prophylaxis, and treatment. J. Cardiothorac. Vasc. Anesth., 2016, vol. 1, no. 30, pp. 200-216.

29. MacLay J.D., MacNee W. Cardiovascular disease in COPD: mechanisms. Chest, 2013, no. 143, pp. 798-807.

30. Mahler D.A., Wells C.K. Evaluation of clinical methods for rating dyspnea. Chest, 1988, no. 93, pp. 580-586.

31. Manganas H., Lacasse Y., Bourgeois S. et al. Postoperative outcome after coronary artery bypass grafting in chronic obstructive pulmonary disease. Can. Respir. J., 2007, no. 14, pp. 19-24.

32. Mannino D.M., Thorn D., Swensen A. et al. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur. Respir. J., 2008, no. 32, pp. 962-969.

33. McAllister D.A., Wild S.H., MacLay J.D. et al. Forced expiratory volume in one second predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery: a retrospective cohort study. PLoS One, 2013, no. 8, p. e64565.

34. Medalion B., Katz M.G., Cohen A.J. et al. Long-term beneficial effect of coronary artery bypass grafting in patients with COPD. Chest, 2004, no. 125, pp. 56-62.

35. Mehra R., Benjamin E.J., Shahar E. et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The sleep heart health study. Am. J. Respir. Crit. Care Med., 2006, no. 173, pp. 910-916.

36. Michalopoulos A., Geroulanos S., Papadimitriou L. et al. Mild or moderate chronic obstructive pulmonary disease risk in elective coronary artery bypass grafting surgery. World J. Surg., 2001, no. 25, pp. 1507-1511.

37. Miller M.R., Hankinson J., Brusasco V. et al. Standardisation of spirometry. Eur. Respir. J., 2005, no. 26, pp. 319-338.

38. Montnemery P., Bengtsson P., Elliot A. et al. Prevalence of obstructive lung diseases and respiratory symptoms in relation to living environment and socio-economic group. Respir. Med., 2001, no. 95, pp. 744-752.

39. Mullerova H., Agusti A., Erqou S. et al. Cardiovascular comorbidity in COPD: systematic literature review. Chest, 2013, no. 44, pp. 1163-1178.

40. O’Boyle F., Mediratta N., Chalmers J. et al. Long-term survival of patients with pulmonary disease undergoing coronary artery bypass surgery. Eur. J. Cardiothoracic. Surg., 2013, no. 43, pp. 697-703.

41. Pellegrino R., Viegi G., Brusasco V. et al. Interpretative strategies for lung function tests. Eur. Respir. J., 2005, no. 26, pp. 948-968.

42. Roques F., Nashef S.A., Michel P. et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur. J. Cardiothorac. Surg., 1999, no. 15, pp. 813-816.

43. Saleh H.Z., Mohan K., Shaw M. et al. Impact of chronic obstructive pulmonary disease severity on surgical outcomes in patients undergoing non-emergent coronary artery bypass grafting. Eur. J. Cardiothorac. Surg., 2012, no. 42, pp. 108–113; discussion 113.

44. Samuels L.E., Kaufman M.S., Morris R.J. et al. Coronary artery bypass grafting in patients with COPD. Chest, 1998, no. 113, pp. 878-882.

45. Spivack S.D., Shinozaki T., Albertini J.J. et al. Preoperative prediction of postoperative respiratory outcome. Coronary artery bypass grafting. Chest, 1996, no. 109, pp. 1222-1230.

46. Standardization of Spirometry, 1994 Update. American Thoracic Society. Am. J. Respir. Crit. Care Med., 1995, no. 152, pp. 1107-1136.

47. Stein M., Cassara E.L. Preoperative pulmonary evaluation and therapy for surgery patients. JAMA, 1970, no. 211, pp. 787-790.

48. Terzano C., Romani S., Conti V. et al. Atrial fibrillation in the acute, hyper-capnic exacerbations of COPD. Eur. Rev. Med. Pharmacol. Sci., 2014, no. 18, pp. 2908-2917.

49. Terzano C., Conti V., Di Stefano F. et al. Comorbidity, hospitalization, and mortality in COPD: Results from a longitudinal study. Lung, 2010, no. 188, pp. 321-329.

50. Thygesen K., Alpert J.S., Jaffe A.S. et al. Third universal definition of myocardial infarction. J. Am. Coll. Cardiol., 2012, no. 60, pp. 1581-1598.

51. Vestbo J., Hurd S.S., Agusti A.G. et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am. J. Respir. Crit. Care Med., 2013, no. 187, pp. 347-365.

52. Wannamethee S.G., Shaper A.G., Papacosta O. et al. Lung function and airway obstruction: associations with circulating markers of cardiac function and incident heart failure in older men-the British Regional Heart Study. Thorax, 2016, no. 71, pp. 526-534.

53. Witte K.K., Clark A.L. Why does chronic heart failure cause breathlessness and fatigue? Prog. Cardiovasc. Dis., 2007, no. 49, pp. 366-384.