title: Influences of chronic obstructive pulmonary disease on outcomes of total arch replacement.
abstract: BACKGROUND
  Although an association between chronic obstructive pulmonary disease (COPD) and adverse surgical outcomes has been proposed, the impact of COPD severity on postoperative outcomes remains unclear. Our objective was to analyze the prognostic implication of COPD severity on outcomes after total aortic arch replacement.
  
  
  METHODS
  Between October 1999 and December 2012, 269 patients undergoing total arch replacement through median sternotomy, who were elective cases with preoperative spirometry records, were retrospectively reviewed. Patients were divided into four groups: control group, with ratio of forced expiratory volume of air in 1 second (FEV1) to forced vital capacity (FVC) of 70% or greater; mild airflow obstruction, with FEV1/FVC ratio less than 70% and FEV1 80% or greater of predicted; moderate airflow obstruction, FEV1/FVC ratio less than 70% and FEV1 50% to 79% of predicted; severe airflow obstruction, FEV1/FVC ratio less than 70% and FEV1 less than 50% of predicted. Symptoms of functional dyspnea and disability were also assessed. Multivariate logistic and Cox regression methods were used to determine if there was an independent association between COPD and short-term and long-term outcomes, respectively.
  
  
  RESULTS
  The in-hospital mortality rate was 2.2% (6 of 269). A consistent trend of increasing frequency of postoperative respiratory complications with advanced airflow obstruction was noted. In multivariate analysis, in-hospital mortality (p = 0.022), incidence of respiratory complications (p = 0.021) and overall mortality (p = 0.025) was significantly associated with the symptoms of COPD, respectively.
  
  
  CONCLUSIONS
  The severity of COPD as deﬁned by spirometry and symptoms of functional dyspnea may be an important prognostic marker of patients undergoing total arch replacement.
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Miyahara
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Nakai
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Izawa
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Yamanaka
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Toshihito
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Nomura
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Matsumori
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Okada
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: yokita@med.kobe-u.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014797:Vital Capacity