Authors
Kuts E.V., Gelashvili M.M., Mironenko V.A., Afanasyeva L.A., Minichkin I.S., Mironenko M.Y., Golukhova E.Z.
Bakulev Medical Research Center for Cardiovascular Surgery, Moscow
Abstract
Objective. To evaluate the impact of preoperative pulmonary function tests (PFTs) on clinical outcomes in patients undergoing surgery for ascending aortic aneurysm.
Methods. 321 patients undergoing surgery for ascending aortic aneurysm were included into the study. All patients underwent PFTs before the surgery. By analysing pulmonary function, the types of respiratory dysfunction were determined based on forced expiratory volume (FEV1) in one second and forced vital capacity (FVC), according to the recommendations of the American and European Respiratory Societies. The criterion for obstructive pattern was a FEV1/FVC ratio < 70%, restrictive pattern was defined as reduced VC (vital capacity), FVC < 80% while maintaining normal FEV1/FVC ratios, and mixed pattern was characterized by reduced FEV1, FVC < 80% and a FEV1/FVC ratio ≤ 70%. An analysis of the relationship between PFTs and early clinical outcomes of surgical treatment was performed.
Results. PFTs were abnormal not only in 74 patients with a diagnosed chronic obstructive pulmonary disease (COPD) but also in patients without COPD (64 patients). In this group, the obstructive pattern was most frequently observed in 14.2% patients, while restrictive and mixed patterns were detected in 6.5% and 5.3% of cases, respectively. According to multifactorial regression analysis, decreased forced vital capacity, restrictive and mixed patterns, duration of cardiopulmonary bypass, aortic clamping time, obesity, type I aortic dissection, and Marfan syndrome significantly increased the duration of mechanical ventilation, stay in the intensive care unit (ICU), and hospital length of stay. Concomitant COPD increased the frequency of respiratory failure after surgery (p = 0.02) and the rate of mortality (p = 0.036).
Conclusions. Assessment of preoperative PFTs prior to surgery allows to predict the complicated outcomes, thus facilitating perioperative planning.
Keywords: pulmonary function tests, ascending aortic aneurysm.
References
1. Teixido-Tura G, Stefano LS, Vinko BV, Bossone E, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC). European Heart Journal. 2024; 45: 3538-3700. doi: 10.1093/eurheartj/ehae179.
2. Praz F, Borger MA, Lanz J, Marin-Cuartas M, et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2025; 00: 1-102. doi: 10.1093/ eurheartj/ehaf194.
3. Gelashvili MM. Treatment outcomes of ascending aortic aneurysms in relation to concomitant pathology. [dissertation] Moscow; 2022. (In Russ.)
4. Mironenko VA, Rychin SV, Badmaev TV, Garmanov SV, Kokoev MB. Short-term results of the N. Kouchoukos modification of aortic valve and ascenting aortic prosthesis in patients with aneurism and discontinuation of the ascending aorta. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2023; 65(2): 191-6. (in Russ.) doi: 10.24022/0236-2791-2023-65-2-191-196.
5. Mironenko VA, Gadzhimuradov SR, Garmanov SV, Kokoev MB. Long-term outcomes of surgical treatment of acute aortic dissection type A according to Stanford. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2024; 66(5): 594-603 (In Russ.) doi: 10.24022/0236-2791-2024-66-5-594-603.
6. Yan Y, Zhang X, Yuntai Y. Postoperative pulmonary complications in patients undergoing aortic surgery: A single-center retrospective study. Medicine (Baltimore). 2023; 102(39). doi: 10.1097/MD.0000000000034668.
7. Henn MC, Zajarias A, Brian R, Lindman B, et al. Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement. J. Thorac Cardiovasc Surg . 2016; 151: 578-86 .doi: 10.1016/j.jtcvs.2015.10.067.
8. Bautin AE, Kasherininov IYu, Laletin DA, Mazurok VA, et al. Prevalence and causes of the postoperative acute respiratory failure in cardiac surgery. Vestnik intensivnoj terapii. 2016; 4: 2-26. (In Russ.) doi: 10.1016/j.bpa. 2015.04.002.
9. Crestanello J, Robert S, Higgins D, Xia He, et al. The Association of Chronic Lung Disease with Early Mortality and Respiratory Adverse Events After Aortic Valve Replacement. Ann. Thorac. Surg. 2014; 98: 2068-77. doi: 10.1016/j.athoracsur.2014.06.087.
10. Eremenko AA, Zulyaeva TP. Postoperative acute respiratory failure in cardiac surgery. Pirogov Russian Journal of Surgery. 2019; (8): 5-11. (In Russ.) doi: 10.17116/ hirurgia20190815.
11. Ponomarev DN, Kamenskaya OV, Klinkova AS, Loginova IYu, et al. Disorders of external respiration and their impact on the clinical outcome in the patients undergoing cardiac surgery. Messenger of Anesthesiology and resuscitation. 2016; 13(6): 4-12. (In Russ.) doi: 10.21292/2078-5658-2016-13-6-4-12.
12. Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur. Respir. J. 2022; 60(1): 2101499. doi: 10.1183/13993003.01499–2021.
13. Glushko LA, Mironenko MYu, Mironenko VA, Averina II, et al. Cardiorespiratory function and contractile reserve with aortic regurgitation after COVID-19 recovery. Creative Cardiology. 2024; 18(4): 514-522. (In Russ.) doi: 10.24022/1997-3187-2024-18-4-514-522.
14. Magee MJ, Herbert MA, Roper KL. Pulmonary Function Tests Overestimate Chronic Pulmonary Disease in Patients with Severe Aortic Stenosis. Ann Thorac Surg. 2013; 96: 1329-35. doi: 10.1016/j.athoracsur.2013.04.123.
15. Kameneva MYu, Cherniak AV, Aisanov ZR, et al. Spirometry: national guidelines for the testing and interpretation of results. Pulmonology. 2023; 33(3): 307-340. (In Russ.) doi: 10.18093/0869–0189–2023–33–3–307–340.
16. Otto C, Nishimura R, Bonow RO, Carabello BA, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020; 143(5). doi: 10.1016/j.jtcvs.2021.04.002.
17. Rinchyenkhand M, Takeru N, Hirasawa K. Association Between Chronic Obstructive Pulmonary Disease and All-Cause Mortality After Aortic Valve Replacement for Aortic Stenosis. Am J Cardiol. 2023; 190: 41-47. doi: 10.1016/j.amjcard.2022.11.007.
18. Chang H-Y, Wei- Ming H, W-M, Wen- Chung Yu, et al. Prognostic Role of Pulmonary Function in Patients with Heart Failure with Reduced Ejection Fraction. Journal of the American Heart Association. 2022; 11(7). doi: 10.1161/JAHA.121.023422.
19. Karacop HB, Karacop E. Improvement of Pulmonary Function in Heart Failure / Patients with Restrictive Patterns Undergoing Transcatheter Aortic Valve Replacement. International Journal of General Medicine. 2021; 14: 5159-5165. doi: 10.2147/IJGM.S309175.
20. Bokeriya LA, Golukhova EZ, Merzlyakov VYu, Shumkov KV, Medresova AT. Risk Factors and Prediction System for the Development of Postoperative Pulmonary Complications in Cardiac Surgery Patients. Creative Cardiology. 2011; 2; 24-36. (In Russ.)
21. James TM, Nores M, John A, Rousou JA, Lin N, et al. Warm Blood Cardioplegia for Myocardial Protection: Concepts and Controversies. Tex Heart Inst J. 2020; 47(2): 108-116. doi: 10.14503/THIJ-18-6909.
