Surgical Aortic Valve Replacement in a Patient with Very Severe Chronic Obstructive Pulmonary Disease.

PATIENTS PRESENTING with abnormal lung function undergoing cardiac surgery have increased morbidity, prolonged intensive care unit (ICU) and hospital stays, and short- and long-term mortalities. 1 Gunter RL Kilgo P Guyton RA et al. Impact of preoperative chronic lung disease on survival after surgical aortic valve replacement. Ann Thorac Surg. 2013; 96: 1322-1328 Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar , 2 Ponomarev D Kamenskaya O Klinkova A et al. Chronic lung disease and mortality after cardiac surgery: A prospective cohort study. J Cardiothorac Vasc Anesth. 2018; 32: 2241-2245 Abstract Full Text Full Text PDF Scopus (8) Google Scholar , 3 Risom EC Buggeskov KB Mogensen UB et al. Preoperative pulmonary function in all comers for cardiac surgery predicts mortality†. Interact Cardiovasc Thorac Surg. 2019; 29: 244-251 Crossref Scopus (5) Google Scholar , 4 Zhao H Li L Yang G et al. Postoperative outcomes of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting surgery: A meta-analysis. Medicine (Baltimore). 2019; 98: e14388 Crossref Scopus (16) Google Scholar Those with severe pulmonary disease have a 10-times greater chance of complications than those with none or mild disease. 2 Ponomarev D Kamenskaya O Klinkova A et al. Chronic lung disease and mortality after cardiac surgery: A prospective cohort study. J Cardiothorac Vasc Anesth. 2018; 32: 2241-2245 Abstract Full Text Full Text PDF Scopus (8) Google Scholar ,5 Viceconte M Rocco IS Pauletti HO et al. Chronic obstructive pulmonary disease severity influences outcomes after off-pump coronary artery bypass. J Thorac Cardiovasc Surg. 2018; 156: 1554-1561 Abstract Full Text Full Text PDF Scopus (10) Google Scholar Severity of chronic lung disease (CLD) is based on spirometry (eg, forced expiratory volume at 1 second [FEV1]) and/or current medication regimen (Table 1). 6 Henn MC Zajarias A Lindman BR et al. Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement. J Thorac Cardiovasc Surg. 2016; 151 (586.e1-2): 578-585 Abstract Full Text Full Text PDF PubMed Google Scholar , 7 Mirza S Clay RD Koslow MA et al. COPD guidelines: A review of the 2018 GOLD report. Mayo Clin Proc. 2018; 93: 1488-1502 Abstract Full Text Full Text PDF PubMed Scopus (258) Google Scholar , 8 Pellegrino R Viegi G Brusasco V et al. Interpretative strategies for lung function tests. Eur Respir J. 2005; 26: 948-968 Crossref PubMed Scopus (4340) Google Scholar Table 1Pulmonary Function and Dysfunction Classification for Patients With Chronic Obstructive Pulmonary Disease GOLD Severity FEV1% Predicted FEV1/FVC Miscellaneous GOLD 1 No or mild COPD ≥ 75-80% ≥70% None or Bronchodilators GOLD 2 Moderate 50-79% <70% Inhaled Steroid GOLD 3 Severe 30-49% <70% RA SaO2 60 mmHg and/or RA PaCO2 >50 mmHg GOLD 4 Very severe < 30% <70% Four groups are described based on spirometry and symptoms/signs (dyspnea, cough, sputum production, wheezing and /or chest tightness), medications, and arterial blood gas analysis. 6 Henn MC Zajarias A Lindman BR et al. Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement. J Thorac Cardiovasc Surg. 2016; 151 (586.e1-2): 578-585 Abstract Full Text Full Text PDF PubMed Google Scholar , 7 Mirza S Clay RD Koslow MA et al. COPD guidelines: A review of the 2018 GOLD report. Mayo Clin Proc. 2018; 93: 1488-1502 Abstract Full Text Full Text PDF PubMed Scopus (258) Google Scholar , 8 Pellegrino R Viegi G Brusasco V et al. Interpretative strategies for lung function tests. Eur Respir J. 2005; 26: 948-968 Crossref PubMed Scopus (4340) Google Scholar Abbreviations: COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in the first second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; RA, room air; SaO2, arterial oxygen saturation. Open table in a new tab Four groups are described based on spirometry and symptoms/signs (dyspnea, cough, sputum production, wheezing and /or chest tightness), medications, and arterial blood gas analysis. 6 Henn MC Zajarias A Lindman BR et al. Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement. J Thorac Cardiovasc Surg. 2016; 151 (586.e1-2): 578-585 Abstract Full Text Full Text PDF PubMed Google Scholar , 7 Mirza S Clay RD Koslow MA et al. COPD guidelines: A review of the 2018 GOLD report. Mayo Clin Proc. 2018; 93: 1488-1502 Abstract Full Text Full Text PDF PubMed Scopus (258) Google Scholar , 8 Pellegrino R Viegi G Brusasco V et al. Interpretative strategies for lung function tests. Eur Respir J. 2005; 26: 948-968 Crossref PubMed Scopus (4340) Google Scholar Abbreviations: COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in the first second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; RA, room air; SaO2, arterial oxygen saturation.