[Cardiovascular surgery for patients with chronic respiratory failure and respiratory dysfunction]

Chronic obstructive pulmonary disease is one of the major comorbidities in elderly patients with heart disease and thoracic aneurysm because of an overlap of risk factors. Although postoperative ventilator dependency is a major concern, recent study has suggested chronic obstructive pulmonary disease (COPD) was not a risk factor for postoperative prolonged mechanical ventilator support for off-pump coronary artery bypass grafting. Cardiopulmonary bypass may induce acute lung injury, but short-term cardiopulmonary bypass alone does not give adverse effect in clinical practice. Perioperative airway management including quitting smoking, use of bronchodilator, avoiding excessive tracheal suction, and early extubation may contribute satisfactory outcome. However, a stage IV COPD patient is contraindicated for cardiac surgery. Patients with interstitial lung disease can undergo cardiac surgery safely if they have moderate performance status even when patients are under home oxygen therapy.