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The Annals of Thoracic Surgery, Vol 50, 268-273, Copyright © 1990 by The Society of Thoracic Surgeons
N Shapira, SM Zabatino, S Ahmed, DM Murphy, D Sullivan and GM Lemole
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 less than 0.0001), whereas the decreases in functional residual capacity
and expiratory reserve volume at discharge were affected by IMA dissection
(p less than 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.
ARTICLES
Determinants of pulmonary function in patients undergoing coronary bypass operations
Department of Surgery, Medical Center of Delaware, Wilmington 19713.
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