Impact of vital capacity on outcome after total arch replacement
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ORIGINAL ARTICLE
Impact of vital capacity on outcome after total arch replacement Kohei Hachiro1 · Takeshi Kinoshita1 · Tomoaki Suzuki1 · Tohru Asai1 Received: 29 October 2019 / Accepted: 17 January 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives Although chronic obstructive pulmonary disease has been recognized as a significant risk factor for open-heart surgery, the relationship between vital capacity and postoperative outcomes remains unclear. Our objective was to analyze the effect of vital capacity on outcomes after total arch replacement. Methods Between January 2003 and December 2018, 228 patients undergoing total arch replacement who were elective cases with preoperative spirometry records were retrospectively reviewed. Patients were divided into two groups, based on whether their preoperative vital capacity was less than or greater than 2.5 L. We compared perioperative data and long-term outcome after adjusting their backgrounds by propensity score matching analysis. Results The lower vital capacity group had more tracheostomy patients (5.1% vs 0.0%; p = 0.045). The actuarial survival rate was 58.0% in the lower vital capacity group and 86.3% in the higher vital capacity group at 8 years. Log-rank analysis revealed a significant difference between the two groups (p = 0.011). In the multivariate Cox proportional hazard model, vital capacity < 2.5 L (p = 0.024) and estimated glomerular filtration rate < 30mL/minute/1.73 m2 (p = 0.012) showed a significant association with a higher risk of long-term mortality. Conclusions Vital capacity should be considered an important risk factor for postoperative respiratory complications and long-term mortality in patients undergoing total arch replacement. Keywords Vital capacity · Total arch replacement
Introduction Chronic obstructive pulmonary disease (COPD) has been recognized as a significant risk factor for cardiovascular surgery [1–9]. The therapeutic strategy for aortic arch aneurysms is shifting to endovascular management in highrisk patient groups. However, total arch replacement (TAR) remains a necessary treatment even in this endovascular era. TAR is still a challenging operation and preoperative risk evaluation and patient selection are of great importance. Decreased vital capacity as a result of reduced inspiratory muscle function is not only due to COPD, but also may be associated with a deterioration of general condition or frailty. In postoperative management, inspiratory muscle dysfunction is often augmented by wound pain or physical * Takeshi Kinoshita [email protected]‑med.ac.jp 1
Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga 520‑2192, Japan
exhaustion, which is directly linked to pneumonia associated with atelectasis and reduced motivation for rehabilitation. To date, the influence of vital capacity on the surgical outcome of TAR remains unclear, so we thought to retrospectively analyze our series of TAR to clarify it.
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