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[Cardiac surgery in underlying chronic pulmonary disease. Prognostic implications and efficient preoperative
D Fistera1, H Steveling, A Koch
1Ruhrlandklinik, Westdeutsches Lungenzentrum, Universitätsklinikum Essen, Tüschener Weg 40, 45239, Essen, Deutschland, david.fistera@ruhrlandklinik.uk-essen.de.
Herz
|January 24, 2014
Summary
Patients with chronic pulmonary diseases undergoing cardiac surgery face high risks of postoperative pulmonary complications (PPC). Risk stratification is key, as conditions like COPD significantly increase PPC risk, unlike well-controlled asthma.
Area of Science:
- Cardiology
- Pulmonology
- Anesthesiology
Context:
- Cardiac surgery patients often have chronic pulmonary diseases, increasing risks.
- Postoperative pulmonary complications (PPC) are a significant cause of mortality (5-8%) after cardiac surgery.
- Not all pulmonary conditions equally elevate surgical risk.
Purpose:
- To review the risk of postoperative pulmonary complications (PPC) in cardiac surgery patients with chronic pulmonary diseases.
- To differentiate risk levels associated with various pulmonary conditions.
- To emphasize preoperative risk stratification and perioperative management.
Summary:
- Chronic pulmonary diseases increase cardiac surgery risks, with COPD and obstructive sleep apnea being high-risk factors.
- Well-controlled asthma does not significantly add to PPC risk.
- Preoperative risk calculators (e.g., Canet score) aid risk estimation, but pulmonary function testing offers limited additional value beyond history and physical exam.
- No established pulmonary function thresholds mandate denying indicated cardiac surgery.
Impact:
- Highlights the critical need for thorough preoperative risk assessment in cardiac surgery patients with pulmonary disease.
- Informs clinical decision-making regarding risk stratification and management strategies.
- Underscores the importance of applying perioperative risk reduction strategies universally.
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