Clinical significance of chronic obstructive pulmonary disease in patients undergoing elective total arch replacement: analysis based on the Japan Adult Cardiovascular Surgery Database

OBJECTIVE: We investigated the impact of chronic obstructive pulmonary disease (COPD) on in-hospital outcomes of patients undergoing conventional total aortic arch replacement (TAR), based on the Japan Adult Cardiovascular Surgery Database. METHODS: A total of 12 590 patients who underwent elective TAR between 2008 and 2013 were retrospectively reviewed. Patients were divided into 4 categories: normal respiratory function (control), with ratio of forced expiratory volume of air in 1 s (FEV1) to forced vital capacity (FVC) of 76% or greater (TAR, n = 10 040); mild COPD, with FEV1/FVC ratio 60-75% and/or use of bronchodilator (TAR, n = 1890); moderate COPD, FEV1/FVC ratio 50 to 59% and/or use of steroids (TAR, n = 504); and severe COPD, FEV1/FVC ratio less than 50% and/or presence of respiratory failure (TAR, n = 156). RESULTS: In-hospital mortality was 5.7% (5.2% in controls, 7.0% in mild COPD, 9.3% in moderate COPD and 9.0% in severe COPD). A significant trend towards the severity of COPD was noted (P < 0.0001). A higher incidence of postoperative pneumonia (6.0% in control, 11.0% in mild COPD, 12.3% in moderate COPD and 15.4% in severe COPD; P < 0.0001) and a greater need for prolonged ventilation (17.5% in control, 22.0% in mild COPD, 26.6% in moderate COPD and 29.5% in severe COPD; P < 0.0001) were observed in cases of more severe COPD. The odds ratio of moderate/severe COPD for in-hospital mortality was 1.44 with confidence interval of 1.08-1.91 (P = 0.012). CONCLUSIONS: There was a significant increase in in-hospital mortality and morbidity with increasing severity of COPD in patients who underwent TAR.