Chronic Obstructive Pulmonary Disease and Off-Pump Coronary Surgery

Risk Factors of Prolonged Mechanical Ventilation in Post Coronary Artery Bypass Graft Patients: A Scoping Review

Prolonged mechanical ventilation (PMV) following CABG surgery is associated with increased patient morbidity and mortality. A consensus has yet to be reached regarding the time limit for PMV. Various studies have identified factors that influence PMV in patients following CABG surgery, but a review has yet to synthesize the results systematically. This review aimed to identify the definition and factors associated with PMV in patients following isolated CABG surgery. This scoping review used the framework developed by Arksey and O'Malley (2005). Primary sources of information were searched through 5 databases: PubMed, Scopus, Oxford Academy, Sage, and CINAHL and two search engines: Science Direct and Google Scholar, accessed on October 25, 2023. Eight articles with a total of 12,178 participants were included in this review. The PMV time limits used in the studies varied from >12 hours to >48 hours. The factors affecting PMV were grouped into preoperative, intraoperative and postoperative, with factors that have a high influence, including NYHA class, acute kidney injury and mediastinitis. Differences in the number of factors examined, criteria, characteristics, and time limits of the PMV used to make the study's results vary. Establishing guidelines regarding PMV time limits is essential according to current conditions.

Prognostic impact of chronic obstructive pulmonary disease on short-term and long-term outcomes following coronary artery bypass grafting

Chronic obstructive pulmonary disease (COPD) is a common condition that complicates major surgeries like coronary artery bypass grafting (CABG). This study aims to evaluate the impact of COPD on the outcome of CABG. A registry-based retrospective cohort study included individuals who received CABG between 2009 and 2016. Data were collected on patient demographics, intraoperative factors, and postoperative outcomes. Cox proportional hazard with inverse probability weighting (IPW) and propensity score matching (PSM) were conducted to assess the adjusted effect of COPD on 30-day and long-term mortality and major adverse cardiac and cerebrovascular events (MACCE). Moreover, the impact of COPD in smokers and non-smokers on short/long-term outcomes was assessed. Sensitivity analysis was conducted using multiple imputations. In the present investigation, 17,315 patients including 629 with COPD (mean age 69 ± 9.74), were followed up for a median duration of 8.25 years. Although COPD did not increase 30-day mortality and MACCE risk, the models showed that patients with COPD are at a significantly higher risk of long-term mortality and MACCE after CABG (IPW: HR for mortality: 1.53, 95% CI: 1.31-1.79; HR for MACCE: 1.29, 95% CI: 1.12-1.47). After multiple imputations, the mortality and MACCE hazard ratio in IPW analysis remained statistically significant. COPD significantly increases long-term mortality and MACCE following CABG, independent of smoking status.

A Scoping Review of Factors Associated with Delayed Extubation in Post Cardiac Surgery Patients

Background

Delayed extubation (DE) after cardiac surgery is associated with high morbidity, mortality, increased length of stay in the intensive care unit, and hospital costs. Various studies have identified factors that influence the occurrence of DE in patients after cardiac surgery, but no review has systematically synthesized the results.

Purpose

This review aimed to identify the influencing factors and the leading causes of DE in patients after cardiac surgery.

Methods

This scoping review uses the framework developed by Arksey and O'Malley (2005). Literature was searched through four databases: PubMed, Scopus, Science Direct, and CINAHL, and two search engines, Sage and Google Scholar, accessed on October 20, 2024. The articles analyzed met the inclusion criteria, such as full-text articles in English, published from 2014-2024, with case-control, cross-sectional, longitudinal, and cohort study designs and had good quality as assessed using the Joanna Briggs Institute critical appraisal checklist. Data was synthesized using thematic analysis.

Results

Eight articles with a total of 13801 participants were included in this review. The prevalence of DE after cardiac surgery ranged from 13.6% to 91.9%. The factors affecting DE were categorized into preoperative, intraoperative and postoperative. The factors most commonly reported to influence ED include preoperative factors (age ≥ 60 and EF < 50%), intraoperative factors (duration of surgery ≥7 hours, use of IABP and sedatives), and postoperative factors (BNP≥806 pg/mL). The leading causes of DE after cardiac surgery are hemodynamic instability requiring increased inotropes (33.51%), reduced level of consciousness or drowsiness (31.91%), and postoperative bleeding (20.74%).

Conclusion

The process of extubation is a crucial phase in postoperative care. By comprehending the elements that impact DE, healthcare providers can effectively allocate medical resources to enhance the success of weaning, extubation, and recovery following cardiac surgery. Consequently, further research focusing on DE is essential, particularly in patients who have undergone cardiac surgery.

Global Insights into Chronic Obstructive Pulmonary Disease and Coronary Artery Disease: A Systematic Review and Meta-Analysis of 6,400,000 Patients

Background

The high prevalence of chronic obstructive pulmonary disease (COPD) in coronary artery disease (CAD) has been acknowledged over the past decade, although the cause/s remain uncertain due to differences in diagnoses. COPD has also become a leading CAD comorbidity, although again little is known about its interactions. This meta-analysis explored COPD prevalence in the global CAD population, as well as the influence of COPD on CAD.

Methods

PubMed, Web of Science, Embase, and grey literature were searched until 26th November 2021. The prevalence of COPD was calculated, and data were grouped according to COPD diagnostic methods, interventions, region, economic status, etc. Outcomes including all-cause death, cardiac death, myocardial infarction, revascularization, stroke, heart failure, and respiratory failure were analyzed. This study was registered with PROSPERO (CRD No.42021293270).

Results

There was an average prevalence of 14.2% for COPD in CAD patients (95% CI: 13.3-15.1), with diagnostics of COPD through spirometry, International Classification of the Diseases (ICD codes), and self-reported methods. Comorbid COPD-CAD patients were more likely to be smokers and suffer from cardiovascular and respiratory complications (all odds ratios [OR] > 1). COPD-CAD has higher mortality (hazard ratio [HR] 2.81, 95% CI: 2.40-3.29), and myocardial infarction, stroke, and respiratory failure rates (all HR > 1). Coronary artery bypass graft (CABG) reduces the need for revascularization (HR 0.43, 95% CI: 0.20-0.94) compared to percutaneous coronary intervention (PCI), without increasing mortality.

Conclusions

The global prevalence of COPD is particularly high in CAD patients. COPD-CAD patients are more likely to encounter cardiovascular and respiratory complications and endure poorer outcomes. Limited evidence suggests that CABG may reduce the need for revascularization without increasing mortality, although further research is required to confirm these observations.

Prolonged Mechanical Ventilation Following Coronary Artery Bypass Graft in Santiago De Cali, Colombia

Purpose

The purpose of this study was to describe factors associated with prolonged ventilatory support in subjects undergoing coronary artery bypass graft.

Patients and Methods

This was an analytical retrospective case-control study. Cases were defined as subjects requiring prolonged mechanical ventilation (>48 hours) following isolated coronary artery bypass graft. Subjects older than 18 years who had undergone surgery were included, while subjects with missing clinical record data, subjects in coma or subjects with prior cardiac surgery were excluded. Variables were measured at the three time points surrounding surgery.

Results

A total of 204 cases and 408 controls were included. The final logistic model showed an association between prolonged mechanical ventilation and the following presurgical variables: chronic obstructive pulmonary disease (OR 1.85; 95% CI: 1.06-3.23, p = 0.03) and chronic kidney disease (OR 1.90; 95% CI: -3.31; p = 0.02). The associated transurgical variable was the use of intra-aortic balloon pump (OR 3.63; 95% CI: 1.73-7.61, p = 0.00), and associated postsurgical variables were venous oxygen saturation <60% (OR 2.00; 95% CI: 1.18-3.40, p = 0.01), mediastinitis (OR 18.51; 95% CI: 4.06-84.40, p = 0.00), inotrope use (OR 2.82; 95% CI: 1.77-4.48, p = 0.00), pleural effusion requiring drainage (OR 3.57; 95% CI: 2.02-6.32, p = 0.00) and delirium (OR 3.45; 95% CI: 1.91-6.25, p = 0.00).

Conclusion

This study identifies factors associated with prolonged mechanical ventilation in subjects subject to coronary artery bypass graft over the presurgical, transurgical and postsurgical periods, identifying a new factor, delirium, for this type of population.

Construction and Validation of a Recurrent Risk Nomogram Model for Non-Small Cell Lung Cancer within 1 Year after Radical Resection

Objective

To explore the risk factors of recurrence within 1 year after radical resection of non-small cell lung cancer (NSCLC) and construct the nomogram model.

Methods

The clinical data of 186 patients with NSCLC treated with radical surgery in Affiliated Hospital of Youjiang Medical University for Nationalities of Baise were retrospectively analyzed. Multivariate logistic regression was applied to analyze the risk factors of recurrence within 1 year after radical resection of NSCLC. The R language (R 4.0.3 software package) was used in constructing the nomogram model, and the predictive value of the model was evaluated.

Results

The recurrence rate of 186 patients within 1 year after radical surgery was 29.57%. After multivariate logistic regression analysis, pathological stage, number of lymph node metastasis, chronic obstructive pulmonary disease (COPD), postoperative plasma D-dimer, and carcinoembryonic antigen were independent factors for recurrence within 1 year after radical resection of NSCLC (P < 0.05). Based on the above independent risk factors, a nomogram model was established, with the distinction of AUC = 0.891 (95% CI: 0.819–0.964) and sensitivity and specificity of 70.3% and 97.8%, respectively. The calibration curve was close to the ideal curve. External validation of the model showed AUC = 0.801 (95% CI: 0.674–0.928), and sensitivity and specificity were 66.7% and 84.2%, respectively.

Conclusion

The recurrence of NSCLC within 1 year after radical surgery was related to a variety of factors, and the nomogram model constructed based on risk factors had good goodness of fit, calibration, consistency of prediction, and prediction efficiency.

Impact of chronic obstructive pulmonary disease on 10-year mortality after percutaneous coronary intervention and bypass surgery for complex coronary artery disease: insights from the SYNTAX Extended Survival study

Aims

To evaluate the impact of chronic obstructive pulmonary disease (COPD) on 10-year all-cause death and the treatment effect of CABG versus PCI on 10-year all-cause death in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) and COPD.

Methods

Patients were stratified according to COPD status and compared with regard to clinical outcomes. Ten-year all-cause death was examined according to the presence of COPD and the revascularization strategy.

Results

COPD status was available for all randomized 1800 patients, of whom, 154 had COPD (8.6%) at the time of randomization. Regardless of the revascularization strategy, patients with COPD had a higher risk of 10-year all-cause death, compared with those without COPD (43.1% vs. 24.9%; hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.56–2.64; p < 0.001). Among patients with COPD, CABG appeared to have a slightly lower risk of 10-year all-cause death compared with PCI (42.3% vs. 43.9%; HR: 0.96; 95% CI: 0.59–1.56, p = 0.858), whereas among those without COPD, CABG had a significantly lower risk of 10-year all-cause death (22.7% vs. 27.1%; HR: 0.81; 95% CI: 0.67–0.99, p = 0.041). There was no significant differential treatment effect of CABG versus PCI on 10-year all-cause death between patients with and without COPD (p_interaction = 0.544).

Conclusions

COPD was associated with a higher risk of 10-year all-cause death after revascularization for complex coronary artery disease. The presence of COPD did not significantly modify the beneficial effect of CABG versus PCI on 10-year all-cause death.

Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050

Graphic abstract

A Double-Blind Randomized Controlled Trial to Determine the Preventive Effect of Hangekobokuto on Aspiration Pneumonia in Patients Undergoing Cardiovascular Surgery

PURPOSE

This study aimed to assess whether hangekobokuto (HKT) can prevent aspiration pneumonia in patients undergoing cardiovascular surgery.

METHODS

We performed a single-center, double-blinded, randomized, placebo-controlled study of HKT in patients undergoing cardiovascular surgery. JPS HKT extract granule (JPS-16) was used as HKT. The primary endpoint was defined as the prevention of postoperative aspiration pneumonia. The secondary endpoints included complete recovery from swallowing and coughing disorders.

RESULTS

Between August 2014 and August 2015, a total of 34 patients were registered in this study. The rate of subjects with postoperative aspiration pneumonia was significantly lower in the HKT group than in the placebo group (p = 0.017). In high-risk patients for aspiration pneumonia, the rate was significantly lower in the HKT group than in the placebo group (p = 0.015). The rate of subjects with swallowing disorders tended to be lower in the HKT group than in the placebo group (p = 0.091), and in high-risk patients, the rate was significantly lower in the HKT group than in the placebo group (p = 0.038).

CONCLUSIONS

HKT can prevent aspiration pneumonia in patients undergoing cardiovascular surgery. In high-risk patients for aspiration pneumonia, HKT can prevent aspiration pneumonia and improve swallowing disorders.