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• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

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• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Poor lung function has been identified as an important risk factor for cardiac surgery, causing worse postoperative outcomes. Various minimally invasive techniques have evolved in time and have been shown to provide significant benefits in high-risk patients. However, these claims have yet to be validated in Belgian patients with chronic respiratory disease (CRD). This study aimed to examine the effect of poor preoperative lung function in CRD patients on surgical outcomes following sternotomy, minimally access or transcatheter cardiac surgery. Additionally, the effect of the incision type across the degree of poor lung function was investigated. In this retrospective, CRD patients who underwent cardiac surgery at UZ Leuven between January 2017 and December 2020 were included and divided into two ways. First, three groups were formed based on incision type, further divided into three subgroups by lung function severity. Second, three cohorts were formed based on lung function severity, further subdivided into three subgroups by incision type. The Global initiative for chronic Obstructive Lung Disease (GOLD) definition was used to divide patients according to spirometry data: mild CRD (forced expiratory volume in 1 s [FEV1] ≥80%), moderate CRD (FEV1 ≥50%) and severe CRD (FEV1 <50%). Clinical follow-up data was used up until October 2021. Focus was on total postoperative overall hospital length of stay (LOS), intensive care unit (ICU) LOS, intubation duration and overall survival. Among the 582 cases, 409 (median age 65-80, 65.8% male) were preserved as the overall cohort; (mild CRD, n = 132; moderate CRD, n = 211; severe CRD, n = 66) and ((sternotomy, n = 226; minimal access surgery (MAS), n = 104, transcatheter (TC), n = 79)). In all incision groups, a longer overall hospital LOS by lung function severity was observed. In both sternotomy and MAS groups, ICU LOS increased as lung function severity worsened as well as intubation duration extended. Mild CRD was associated with significant higher overall survival in the sternotomy group. In all lung function groups a positive trend toward longer overall hospital LOS, ICU LOS and extended intubation duration by incisional invasiveness was noticed. In moderate CRD, increasing incisional invasiveness was even associated with an increase in ICU LOS, whereas it was associated with increased intubation duration in mild and severe CRD. MAS was associated with increased overall survival in moderate CRD compared with sternotomy and transcatheter (p = .003). In LF3 the same trend as in LF2 was seen. To conclude, this study adds suggestive evidence to the existing knowledge as preoperative lung function worsened, overall hospital LOS and ICU LOS increased and intubation duration extended in sternotomy and MAS surgery. According transcatheter, this was only in the case of overall hospital LOS. The same suggestions can be made as the incision type became more invasive across three stages of poor lung function. According long-term outcomes, MAS has a protective effect in worse lung function severity compared to sternotomy.

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Cardiopulmonaire bypass biedt enorm veel mogelijkheden voor de cardiale heelkunde. Er bestaat echter heel wat controverse omtrent het temperatuursmanagement tijdens deze soort ingrepen. Hoewel de hart- en longfunctie kunstmatig worden overgenomen, zijn er mogelijke negatieve effecten voor het lichaam. Geïnduceerde hypothermie tijdens cardiopulmonaire bypass zou de vitale organen, in het bijzonder de hersenen, beschermen tijdens periodes van eventuele hypoxie. Daartegenover geeft hypothermie ook een verhoogde incidentie van myocardiale complicaties en aritmieën, coagulopathieën en een verhoogd risico voor infectie. Heden bestaat er nog geen bewijs van een significant voordeel voor hypothermie, dan wel voor normothermie. Het is wel duidelijk dat hyperthermie ten alle tijden vermeden worden gezien dit een onevenwicht van het cerebrale zuurstofmetabolisme veroorzaakt, alsook de vorming van embolen tot stand brengt wat een enorme impact heeft op de uiteindelijke overleving en neurologische outcome. Daarbij is de periode van heropwarmen na hypothermie een risicovolle periode voor hyperthermie met al zijn complicaties. Een nauwgezette monitoring en controle van de temperatuur dient gedurende de volledige procedure te worden voorzien. Men dient steeds onder de maximale gemeten lichaamstemperatuur van 37 °C te blijven ten einde hyperthermie te voorkomen.