Simultaneous cardiac surgery with pulmonary resection: presentation of series and review of literature

• Published in: European journal of cardio-thoracic surgery Vol. 13; no. 6; pp. 667 - 672
• Main Authors: Danton, Mark H.D., Anikin, Vladimir A., McManus, Kieran G., McGuigan, James A., Campalani, Gianfranco
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Science B.V 01-06-1998; Elsevier Science
• Subjects: Aged; Biological and medical sciences; Cardiac surgery; Cardiopulmonary Bypass; Coronary Artery Bypass; Female; Humans; Lung cancer; Lung Neoplasms - complications; Lung Neoplasms - surgery; Male; Medical sciences; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - surgery; Pneumonectomy; Respiration, Artificial; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Heart; Human; Prognosis; Combined surgery; Surgery; Mortality; Lung; Evolution; Surgical resection; Technique; Morbidity
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(98)00088-8

Background: The issue of performing simultaneous pulmonary resection and cardiac surgery in patients with coexisting lung carcinoma and ischaemic heart disease remains controversial. We report our experience and review the literature. Methods: Thirteen patients (male ten, female three; mean age 65 years) underwent simultaneous cardiac surgery and pulmonary resection. Lung pathology consisted of primary lung carcinoma (n=10), benign disease (n=2) and carcinoid (n=1). Lung resections included pneumonectomy (n=3), lobectomy (n=4), segmentectomy (n=1) and local excision (n=5). Cardiac procedures consisted of coronary artery bypass grafting (CABG) in 11, aortic valve replacement in one and mitral valve repair with CABG in one patient. In all but one case the lung resection was performed prior to heparinization and cardiopulmonary bypass (CPB). In two patients, with suitable coronary anatomy, myocardial revascularization without CPB was performed to reduce morbidity. Results: There was no hospital mortality. Postoperative blood loss and ventilation requirements were reduced in the patients who were operated on without CPB. Prolonged ventilatory support was required in two cases. All patients with benign pathology are alive. In the lung cancer group there have been five late deaths: disseminated metastatic disease (n=3), anticoagulant related haemorrhage (n=1) and broncho-pleural fistula (n=1). Of the remaining five patients four are alive and disease free 7–23 months post-operatively; one patient has recurrent disease 40 months post-operatively. Conclusions: Simultaneous pulmonary resection and cardiac surgery is associated with acceptable operative morbidity and mortality. In patients with lung carcinoma long-term survival was determined by tumour stage. The avoidance of CPB may be advantageous by decreasing blood loss and ventilation requirements.