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The Outcomes Of Concomitant Off-pump Coronary Artery Bypass Grafting And Pulmonary Operations
Mehmet S. Ates1, Zumrut T. Demirozu
1, Suat Erus
1, Eray Aksoy
2, Kadir B. Ozer
1, Sami Gurkahraman
2, Ekin E. Cesur
2, Serhan Tanju
1.
1Koc School of Medicine, Istanbul, Turkey,
2VKF American Hospital, Istanbul, Turkey.
OBJECTIVE: The aim of this retrospective study was to analyze the early and long-term outcomes of the concomitant off-pump coronary artery bypass grafting (CABG) surgery and pulmonary resection for lung cancer or thoracic mass.
METHODS: From March 2018 through February 2024, 23 patients (17 women and 6 men) with a mean age of 69±6.5 years (range 59-83 years) underwent concomitant off-pump coronary artery bypass grafting and thoracic surgery procedures for lung cancer or thoracic mass. The surgical approach was median sternotomy for off-pump CABG and video-assisted thoracic surgery (VATS) was preferred for lung tumor resections. Mortality, major adverse cardiac, cerebrovascular events, length of duration in hospital were evaluated.
RESULTS: There were no postoperative deaths or perioperative myocardial infarctions (MI). None of the patients had experienced pneumothorax and/or atelectasis. None of the patients sustained excessive blood loss requiring reoperation. Complete revascularization with multiarterial grafts was the first choice, followed by mainly VATS; including wedge resections, lobectomies, segmentectomies. All the patients were followed-up for 6 to 86 months. Four patients died in postoperative 1-year period, and the other patient died postoperative 29th month due to cancer relapse. Over-all 1-year survival was 86.5% and 3-year, 5-year survival was 74%.
CONCLUSIONS: We believe that the VATS approach provides a better perspective for pulmonary resection than the sternal view due to more ample, wider workspace and mediastinal lymph node dissection (mLND) which has importance in patients' final diagnosis. Combined off-pump CABG and pulmonary resection in patients with lung cancer is safe and effective, spares the patient cost and possible complications of a second major surgery.
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