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Ann Thorac Surg 1990;50:268-273
© 1990 The Society of Thoracic Surgeons
a Section of Cardiovascular Surgery, Department of Surgery, The Medical Center of Delaware, Wilmington, Delaware USA
b Section of Pulmonary Medicine, Deborah Heart and Lung Center, Browns Mills, New Jersey USA
c Division of Biostatistics and Epidemiology, Georgetown University, Washington, DC USA
Accepted for publication March 10, 1990.
* Address reprint requests to Dr Shapira, The Medical Center of Delaware, 4745 Stanton-Ogletown Rd, Suite 205, Newark, DE 19713.
Pulmonary function testing was conducted consecutively in 29 healthy men (age range, 42 to 71 years) undergoing elective coronary artery bypass grafting. Lung volumes, expiratory flow rates, diffusing capacity, and blood gases were determined before operation, at discharge (8.7 ± 1.9 days), and at 3 months postoperatively. In addition, peak expiratory flow rate was measured immediately after extubation (21.4 ± 2.7 hours). Fifteen patients had smoked within the past year, but none had a history of pulmonary impairment. Twenty-two patients had internal mammary artery (IMA) dissection. Operation and recovery were uneventful in all cases. After extubation, peak expiratory flow rate was decreased by 65%. At discharge, lung volumes were decreased by 19% to 33% below preoperative values and expiratory flow rates were decreased by 33% to 37% below preoperative values. Some minor changes were detected at 3 months. Further analysis of these changes according to smoking history, age, preoperative weight, dissection of IMA, and aortic cross-clamp time showed that only IMA dissection affected the postextubation changes in peak expiratory flow rate (p < 0.0001), whereas the decreases in functional residual capacity and expiratory reserve volume at discharge were affected by IMA dissection (p < 0.05) and age (p = 0.01). Thus, median sternotomy is associated with severe but short-term pulmonary dysfunction; IMA dissection has a significant adverse effect on these changes.
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