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Eur J Cardiothorac Surg 1998;14:107-112
© 1998 Elsevier Science NL
a Department of Cardiothoracic Surgery, University of Vienna, Währinger Gürtel 18–20, A-1090 Vienna, Austria
b Pulmonary Department, Lainz Hospital, Vienna, Austria
c Department of Anesthesiology, University of Vienna, Vienna, Austria
Received 28 September 1997; received in revised form 23 March 1998; accepted 12 May 1998.
Corresponding author. Tel.: +43 1 404005620; fax: +43 1 404005642; e-mail: Wilfried.Wisser@akh-wien.ac.at
Objective: Chronic hypercapnia is still considered to increase the risk for perioperative mortality and therefore to be a contraindication for lung volume reduction surgery (LVRS). The aim of this study was to analyse the influences of hypercapnia upon postoperative outcome. Methods: The functional improvement (preop vs. 3 months postop) and clinical outcome was studied in 22 patients with chronic hypercapnia (preoperative arterial pCO2
45 mmHg) who underwent LVRS between 9/94 and 2/97 and were compared to all other patients (n=58) without hypercapnia. Data are expressed as the mean±SEM. Results: The 30-day mortality was 9.1% (2/22) in patients with chronic hypercapnia (HC) and 5.2% (3/58) in patients with normal arterial pCO2 levels (control) (P=n.s). The stay on the ICU (3.5±0.8 vs. 2.1±0.3 days) and duration of chest drainage (7.3±1.2 vs. 7.2±0.8 days) was similar between both groups (HC vs. control) (P=n.s). The preoperative lung function (% of predicted) and blood gas (mmHg) parameters were significantly worse in HC patients compared to control patients. In both groups significant functional improvements were observed: FeV1 in the control group increased by 37% within the first 3 months (29.1±1.7% of predicted vs. 39.9±3.1% of predicted, P=0.0198). In the HC group, FeV1 increased by 73% which was even higher than in the controls (19.5±1.5% of predicted vs. 33.7±4.7% of predicted, P=0.0385). All patients of both groups who died perioperatively had a significantly higher severity of parenchymal destruction than those who survived (P=0.0277 and 0.0380, respectively). Conclusions: Patients with chronic hypercapnia alone, had no significantly higher mortality and morbidity, and therefore should not be excluded from LVRS. However, the presence of additional risk factors, such as homogeneity of disease, high degree of parenchymal destruction or pulmonary hypertension should be considered as contraindications for the procedure.
Key Words: Lung volume reduction surgery • Diffuse emphysema • Hypercapnia
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