Outcomes in Patients With Severe Chronic Lung Disease Undergoing Index Cardiac Operations

Abstract

This study evaluated the impact of severe chronic lung disease on outcomes of index adult cardiac operations. A single-center, retrospective study of adult patients with severe chronic lung disease (as defined by The Society of Thoracic Surgeons) undergoing index cardiac operations between 2010 and 2018 was performed. Multivariable Cox regression and Kaplan-Meier analyses were used to evaluate survival. Three hundred fifty-four patients (median age, 69 years; 32.77% women) were identified. Current smokers comprised 42.66% of the population, and 34.65% of patients required home oxygen. Median preoperative forced expiratory volume in 1 second was 48% of predicted (interquartile range, 41%-56%), and median diffusing capacity of the lungs for carbon monoxide was 78% of predicted (interquartile range, 55%-101%). Most patients underwent isolated coronary artery bypass (57.06%) or isolated aortic valve replacement (19.49%). Overall, 33 patients (9.07%) required a tracheostomy (median of 10 days from surgery) for a median of 49 days (interquartile range, 25-114) until decannulation. Preoperative home oxygen use was an independent predictor of 30-day (hazard ratio, 2.91; P= .030) and 1-year (hazard ratio, 2.12; P= .009) mortality. One-year and 5-year postoperative survival were 83.62% and 58.34%, respectively. Although severe chronic lung disease is a predictor of mortality and morbidity after index cardiac operations, only 9% of patients required a tracheostomy, and most were alive at 5 years after surgery. Home oxygen use may serve as a further stratification tool in this higher risk subset; however the presence of severe chronic lung disease alone should not deter from surgery in otherwise reasonable surgical candidates.