Coronary artery disease in patients undergoing lung volume reduction surgery for emphysema.

OBJECTIVES Most patients with severe pulmonary emphysema referred for lung volume reduction surgery (LVRS) have a long-standing history of cigarette smoking. Coronary artery disease (CAD) predisposes to perioperative cardiac complications. Since symptoms and signs of myocardial ischemia are often absent in patients with severe ventilatory impairment even during exercise, we investigated the prevalence of CAD in candidates for LVRS by angiography. DESIGN We prospectively studied the prevalence of CAD by angiography and assessed the CAD risk factor profile in 41 candidates for LVRS (26 men, 15 women; mean age, 66+/-6.8 years; range, 52 to 76 years), who had no current symptoms or a history of myocardial ischemia. RESULTS In six patients (15%), asymptomatic but significant coronary lesions (> 70% stenosis) were detected. In five patients, these findings altered the clinical management. Patients with CAD had significant higher cholesterol levels, tended to have smoked more, and had more often additional vascular risk factors. CONCLUSIONS We found a high prevalence of angiographically significant but clinically silent CAD in this particular population of heavy smokers with advanced emphysema.

[1]  G. Snell,et al.  Lung volume reduction surgery for emphysema , 1997, The Medical journal of Australia.

[2]  M. Hauser,et al.  Bilateral volume reduction surgery for diffuse pulmonary emphysema by video-assisted thoracoscopy. , 1996, The Journal of thoracic and cardiovascular surgery.

[3]  R. Gibbons,et al.  ACC/AHA task force report. Special report: guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Perioperative Cardiovascular Evaluation for Noncardiac Sur , 1996, Journal of cardiothoracic and vascular anesthesia.

[4]  J. Miller,et al.  Lung volume reduction surgery: lessons learned. , 1996, The Annals of thoracic surgery.

[5]  P. E. Walters,et al.  Lung volume reduction surgery. Case selection, operative technique, and clinical results. , 1996, Annals of surgery.

[6]  M. Bodenheimer.  Noncardiac Surgery in the Cardiac Patient: What Is the Question? , 1996, Annals of Internal Medicine.

[7]  L. Fleisher,et al.  Screening for Cardiac Disease in Patients Having Noncardiac Surgery , 1996, Annals of Internal Medicine.

[8]  P. E. Krucylak,et al.  Unilateral video-assisted thoracic surgical lung reduction. , 1996, The Annals of thoracic surgery.

[9]  R. Mckenna,et al.  Use of the Heimlich valve to shorten hospital stay after lung reduction surgery for emphysema. , 1996, The Annals of thoracic surgery.

[10]  R. Gibbons,et al.  Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). , 1996, Journal of the American College of Cardiology.

[11]  F. Sciurba,et al.  Unilateral thoracoscopic surgical approach for diffuse emphysema. , 1996, The Journal of thoracic and cardiovascular surgery.

[12]  A. Triantafillou.  Anesthetic management for bilateral volume reduction surgery. , 1996, Seminars in thoracic and cardiovascular surgery.

[13]  E. Trulock,et al.  Results of lung volume reduction surgery in patients with emphysema. The Washington University Emphysema Surgery Group. , 1996, Seminars in thoracic and cardiovascular surgery.

[14]  L. Goldman,et al.  Preoperative assessment of patients with known or suspected coronary disease. , 1995, The New England journal of medicine.

[15]  J. Machac,et al.  Dobutamine thallium 201 perfusion imaging in candidates for lung transplantation. , 1995, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[16]  J. Wain,et al.  Evaluation of ischemic heart disease in potential lung transplant recipients. , 1995, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[17]  J. Cooper,et al.  Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease. , 1995, The Journal of thoracic and cardiovascular surgery.

[18]  C. R. Smith,et al.  Coronary angiography in smokers undergoing evaluation for lung transplantation: is routine use justified? , 1994, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[19]  L. Goldman.  Assessment of perioperative cardiac risk. , 1994, The New England journal of medicine.

[20]  J. Roca,et al.  Standardization of the measurement of transfer factor (diffusing capacity) , 1993, European Respiratory Journal.

[21]  J. Roca,et al.  Standardization of the measurement of transfer factor (diffusing capacity). Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. , 1993, The European respiratory journal. Supplement.

[22]  J E Cotes,et al.  Lung volumes and forced ventilatory flows , 1993, European Respiratory Journal.

[23]  J E Cotes,et al.  Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. , 1993, The European respiratory journal. Supplement.

[24]  W. C. Sheldon,et al.  Guidelines and indications for coronary artery bypass graft surgery. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Coronary Artery Bypass Graft Surgery). , 1991, Journal of the American College of Cardiology.

[25]  V. Froelicher,et al.  Exercise standards. A statement for health professionals from the American Heart Association. , 1990, Circulation.

[26]  G. Friehs,et al.  Reinforced staple line in severely emphysematous lungs. , 1989, The Journal of thoracic and cardiovascular surgery.

[27]  Buist As.  Standardization of spirometry. , 1987 .

[28]  W Grossman,et al.  Estimation of left ventricular volumes in man from biplane cineangiograms filmed in oblique projections. , 1978, The American journal of cardiology.

[29]  S. P. Gupta,et al.  Twelve-minute walking test for assessing disability in chronic bronchitis. , 1976, British medical journal.