The Difference of Spirometry Result before and after Coronary

Artery Bypass Graft Procedure

Yosep Aloys Hamonangan

, Marshal

and Doddy Prabisma Pohan

Department of General Surgery, Universitas Sumatera Utara/ Haji Adam Malik Hospital, Medan, Indonesia

Department of General Surgery, Division of Thoracic and Cardiovascular Surgery, Universitas Sumatera Utara/ Haji

Adam Malik Hospital, Medan, Indonesia

Keywords: Coronary artery bypass graft, spirometry, pulmonary function

Abstract: To evaluate the differences of pulmonary function test before and after CABG procedure. A descriptive

analytic cohort study was performed in Division of Cardiothoracic Surgery, Department of Surgery, H.

Adam Malik General Hospital, Medan, Indonesia from January 2018 to January 2019. All patients was

underwent coronary artery bypass graft procedure in our center from October 2017 to April 2018. A

preoperative pulmonary function test was compared with postoperative CABG results. A total of 35 patients

were included in the study, averaging 57.6 (± 4.6) years old. The

FEV1/FVC before and after CABG

procedure were recorded with the mean value of 75.97

± 6.22 and 89.35 ± 5.59 respectively. A

statistically significant difference was noted (p<0.001). An improvement of pulmonary function test after

CABG was found compared to preoperative pulmonary function test.

1 INTRODUCTION

Coronary Artery Bypass Graft (CABG) is one of the

most common surgical procedure done, account for

approximately 400.000 operation each year in the

United States. In the last decade, there was a trend

towards less CABG procedures due to percutaneous

coronary intervention (Alexander, 2016).

A CABG procedure was introduced in the 1960

by creating two parallel way to bypass the coronary

artery obstruction, using either internal mammary

artery (IMA) or saphenous vein graft (SVG).

Cardiac surgeon mostly prefer SVG in performing

CABG procedure in 1970. However, during the

present days, most patients were underwent the

surgery using a left IMA (LIMA) (S-hikhman,

2011).

One of the drawbacks of CABG procedures is

the negative effect on pulmonary function.

Pulmonary function test such as VC, FVC, FEV1,

FEV1/FVC, and MVV have lower results after the

surgery compared to before surgery (El-Sobkey,

2011). The decreased of the pulmonary function

could remained for 4-6 months, moreover as long as

1 year, after surgery (Westerdahl, 2016).

From these findings, pulmonary complications

after cardiac surgery are multifactor phenomenon

and statistical explanation to describe these

problems is mandatory (El-Sobkey, 2011). In this

study, we aimed to evaluate if there were any

differences of pulmonary function test before and

after CABG procedure.

2 METHODS

A descriptive analytic cohort study was performed to

all patients who underwent CABG procedures in

Division of Cardiothoracic Surgery, Department of

Surgery, H. Adam Malik General Hospital, Medan,

Indonesia from January 2018 to January 2019. All

CABG patients from October 2017 to April 2018

was our first inclusion criteria. In this study all

patients were between 20 to 60 years old, and having

a valid spirometry test results. A history of unstable

cardiovascular condition; cerebral, abdomen, or

pulmonal aneurism; pneumothorax or hemoptysis

for the last month; recent pulmonary or abdominal

surgery; pulmonary infection; and congenital

164

Siregar, Y., Marshal, . and Pohan, D.

The Difference of Spirometry Result before and after Coronary Artery Bypass Graft Procedure.

DOI: 10.5220/0009862501640166

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 164-166

ISBN: 978-989-758-469-5

pulmonary condition were the exclusion criteria in

this study.

Demographic data of all patients who underwent

the CABG procedure in our center, such as age,

gender, and job were recorded, including pulmonary

test result before surgery. After that, the patients

were called back to the hospital and underwent

history taking and physical examination. All eligible

patients were included into the study and underwent

a spirometry test in the integrated diagnostic center

H. Adam Malik General Hospital, Medan,

Indonesia. A calibrated spirometry tool was used,

and a maneuver to perform spirometry test was

demonstrated before the test.

Statistical analysis using paired T-test was done

to evaluate the pulmonary function before and after

CABG procedure.

3 RESULTS

A total of 51 patients were underwent spirometry

examination before CABG procedures, 10 patients

did not come for the spirometry test after CABG

procedures. Six patients were diagnosed with

chronic obstructive pulmonary disease (COPD) and

excluded from the study. Finally, 35 patients were

included in the study. The mean of age of all

participants was 57.6 ± 4.6 years old and men were

noted in 22 patients (62.9%) compared to 13

(37.1%) women.

Table 1: Demographic characteristics

Characteristics (n=35)

Mean ± SD

Age

57.6

± 4.6

FEV1/FVC

Before CABG

75.97%

± 6.22

After CABG

89.35

± 5.59

The

ratio of FEV1 to FVC before and after CABG

procedure were averaging 75.97 ± 6.22 and 89.35 ±

5.59 respectively. These indicate no obstructive

symptoms in all of our patients. Subsequently, a

paired T-test was done and showed a statistically

significant result, p<0.001.

4 DISCUSSION

A significant change was noted in the vital capacity

after miocardiac revascularization. In the first day

postoperative, an approximately 70% decrease was

found in comparison of preoperative result. After

that, a rise will be found gradually, mostly after the

patients out from the hospital. Cardiac surgery was

also proved to have a negative effect on the

pulmonary function. All of the test results, including

VC; FVC; FEV1; FEV1/FVC were lower

postoperatively compared to preoperative setting.

Several studies have supported these findings

(Shenkman et al., 1997; Saxena et al., 2007;

Weissman, 1999; Stenseth et al., 1996; Vaidya et al.,

1996).

Spirometry test was used because it was an

objective, valid, and capable to evaluate pulmonary

function test. Moreover, it was a non-invasive

method especially for postoperative patients.

Pulmonary hypertension could be caused by

combination of increase left atrial pressure,

pulmonary arteriole narrowing, and organic change

in the pulmonary vessels. Pulmonary dysfunction

was related to interstitial and alveolar edema,

reactive fibrosis, previous pulmonary infarct, pleural

effusion, and decrease of pulmonary volume

postoperatively Shenkman et al., 1997; Saxena et al.,

2007; Weissman, 1999; Stenseth et al., 1996; Vaidya

et al., 1996).

Women were tend to have a lower pulmonary

function test score compared to men as they may

have a worse reaction to pain. This may explain the

reason of lower pulmonary function test was noted

in valve replacement surgery compared to CABG.

But further question is whether there could be

another factors explaining the findings. A proposed

mechanism is inflammatory respons that secreted in

the pulmonary system and resulted in pulmonary

dysfunction or edema (Mahmoud et al, 2005; Barnas

et al, 1994). Beside the worse gas exchange, a

decrease in FVC, FEV1, PEF was more common in

a longer cardiopulmonary bypass procedure (more

than 80 minutes) (Kochamba et al, 2000; Chandra et

al, 1998).

Compared to alternative study, we have a similar

result. A difference in pulmonary function test with

spirometry before and after CABG procedure could

be a threshold in assessing respiratory quality in post

CABG patients. An increasing pulmonary function

test after CABG was found compared to

preoperative pulmonary function test.

REFERENCES

Alexander, J.H., Smith, P.K., 2016. Coronary-Artery

Bypass Grafting. N Engl J Med. 374: 1954–1964.

Barnas, G.M., Watson, R.J., Green, M.D., Sequeira, A.J.,

Gilbert, T.B., Kent, J., Villamater, E., 1994. Lung and

chest wall mechanical properties before and after

cardiac surgery with cardiopulmonary bypass.

The Difference of Spirometry Result before and after Coronary Artery Bypass Graft Procedure

165

Chandra, Shenkman, Z., Shir, Y., Weiss, Y.G., et al. 1997.

The effects of cardiac surgery on early and late

pulmonary function. Acta Anaesthesiol Scand

41:1193-1199.

El-Sobkey, S.B., Gomaa, M., 2011. Assessment of

pulmonary function tests in cardiac patients. J Saudi

Hear Assoc. 23: 81–86.

Kochamba, G.S., Yun, K.L., Pfeffer, T.A., Sinte, C.F.,

Khonsari, S., 2000. Pulmonary abnormalities after

coronary arterial bypass grafting operation:

Cardiopulmonary bypass versus mechanical

stabilization. Ann. Thorac. Surg. 69 (5), 1466–1470.

Mahmoud, A.B., Burhani, M.S., Hannef, A.A., Jamjoom,

A.A., AlGithmi, I.S., Baslaim, G.M., 2005. Effects of

modified ultrafiltration on pulmonary function after

cardiopulmonary bypass. Chest 128 (5), 3447–3453.

S–hikhman, M., Scott, A., 2013. Coronary Artery Bypass

Grafting (CABG). J Chem Inf Model. 53: 16891699.

Saxena, P., Luthra, S., Dhaliwal, R.S., Rana, S.S., Behera,

D., 2007. Early changes in pulmonary functions after

mitral valve replacement. Ann. Thorac. Med. 2 (3),

111–117.

Shenkman, Z., Shir, Y., Weiss, Y.G., Bleiberg, B., Gross,

D., 1997. The effects of cardiac surgery on early and

late pulmonary functions. Acta Anaesthesiol Scand.

41:1193–9.

Stenseth, R., Bjella, L., Berg, E.M., Christensen, O.,

Levang, O.W., Gisvold, S.E., 1996. Effects of thoracic

epidural analgesia on pulmonary function after

coronary artery bypass surgery. Eur. J. Cardiothorac.

Surg. 10, 859–865.

Vaidya, R., Husain, T., Ghosh, P.K., 1996. Spirometric

changes after open mitral surgery. J. Cardiovasc.

Surg. 37 (3), 295–300.

Weissman, C., 1999. Pulmonary function after cardiac

and thoracic surgery. Anesth. Analg. 88, 1272.

Westerdahl, E., Jonsson, M., Emtner, M., 2016.

Pulmonary function and health-related quality of life

1-year follow up after cardiac surgery. J Cardiothorac

Surg. 11: 1–8.

Moore, R., Lopes, J., 1999. Paper templates. In

TEMPLATE’06, 1st International Conference on

Template Production. SCITEPRESS.

Smith, J., 1998. The book, The publishing company.

London, 2

edition.

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

166