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Ann Thorac Surg 1990;50:602-606
© 1990 The Society of Thoracic Surgeons

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Articles

Complications after cardiac operations in patients with severe pulmonary impairment

Departments of Medicine and Rehabilitation Medicine, New York University School of Medicine, New York, New York USA

Accepted for publication May 25, 1990.

^_* Address reprint requests to Dr Haas, Rusk Institute, 400 E 34th St, New York, NY 10016.

The postoperative courses of 39 patients with severe lung disease (31 with obstructive disease and 8 restrictive) who underwent a cardiac operation were retrospectively reviewed. The stay in the intensive care unit of the study group was 7.9 ± 10.3 days (mean ± standard deviation) compared with 2.4 ± 3.9 days for the control group (100 patients with less impaired pulmonary function) (p < 0.001). The study group also had a greater number of valve replacements than did the control group (p < 0.01). Patients with obstructive disease had more respiratory complications than did patients with restrictive disease (p < 0.05). There were 21 cases of atelectasis. Effusions were noted in 11 patients. Ten patients had bronchospasm. Bronchial secretions were a major problem in 6 patients. Pneumonia developed in 4 patients, and pneumothorax occurred in 3 others. The two in-hospital deaths were not directly related to pulmonary complications. Our findings indicate that (1) patients with severe lung impairment generally do well after a cardiac operation but have more postoperative pulmonary complications than patients with less impairment; (2) patients with restrictive pulmonary disease appear to fare better than those with obstructive disease; (3) pulmonary function tests can alert the clinician to the possible risk of postoperative complications, but they cannot, by themselves, be used to exclude patients from operation; and (4) patients with severe pulmonary impairment facing valve replacement are at greater risk of pulmonary complications than patients having other types of cardiac surgical intervention.

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