Simultaneous cardiac surgery with pulmonary resection: presentation of series and review of literature (original) (raw)
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Combined heart surgery and lung tumor resection.
Med Sci Monit. 2008 Mar;14(3):CS17-21., 2008
BACKGROUND: Combined heart surgery and lung resection remains a controversial issue. This method facilitates the treatment of two major problems with one intervention, reducing hospitalization cost with acceptable outcomes. On the other hand, skepticism exists related to the effects of cardiopulmonary bypass on malignancy and to a possible greater risk for perioperative bleeding. CASE REPORTS: A retrospective study is presented of five male patients who underwent combined surgical treatment for heart and lung disease in a one-step procedure between November 2004 and November 2006. Three patients underwent aortic valve replacement with right upper lobectomy. The other two patients underwent pulmonary wedge resection, one combined with coronary bypass and the other with ascending aorta replacement. In all cases, pulmonary resection was performed before cardiopulmonary bypass was established. There was no perioperative death. Three patients had uneventful postoperative recovery, one patient developed atrial fibrillation, and the last one temporary neurological dysfunction. There was no increase in postoperative bleeding or in hospital stay. All patients are under follow-up observation with good performance status. In those patients with pulmonary malignancy, no sign of regional or distant recurrence of the disease is observed. CONCLUSIONS: Combined heart surgery and lung resection can be performed without increased mortality and/or morbidity. The synchronous treatment avoids the necessity of a second intervention with economic benefits and excellent results.
Pulmonary resection combined with cardiac operations
The Annals of Thoracic Surgery, 1990
Surgical management of patients with concomitant critical cardiac disease and resectable lung lesions is controversial. During a 7-year period (1982 to 1988),21 patients underwent combined cardiac and pulmonary operations. Patients had cardiac symptoms only; the lung lesions were found on preoperative chest roentgenograms. The pathological diagnosis was established in only 2 of the patients before operation. All underwent concurrent pulmonary resection during cardiac operations requiring extracorporeal circulation. The pulmonary operations included 17 wedge resections and four lobectomies. The final diagnoses in 8 patients with stage I non-small cell he discovery of an asyiriptornatic pulmonary lesion in T a patient immediately before an open heart operation often poses a diagnostic and therapeutic problem. In part, this is due to the controversial issue as to whether one or two operations (combined) should be performed or postponed altogether 11, 21. Usually, these patients have a surgically correctable cardiac disorder and are found to have an associated pulmonary process on a preoperative chest roentgenogram, often a solitary lung nodule. Because unrecognized or untreated lung cancer obviously alters a patient's long-term prognosis after a cardiac operation, if one is to consider performing these operations at the same time, it is important to understand the impact of such combined procedures on survival. Treatment of both diseases at the same time may be preferable provided it can be performed safely with the likelihood of good long-term results. The purpose of this review was to examine our experience with patients who were found to have a lung lesion just before a scheduled cardiac operation and their outcome when the combined approach was used at the State University of New York at Buffalo.
Results of combined pulmonary resection and cardiac operation
The Annals of Thoracic Surgery, 1996
Background. Concomitant lesions of the heart and lung are uncommon, but when present they pose a therapeutic challenge for thoracic surgeons. A combined procedure avoids the need for a second major thoracic procedure and may improve outcomes and provide economic benefit. However, cardiopulmonary bypass may adversely affect the natural history of pulmonary malignancies.
Concomitant cardiac and pulmonary operation: The role of cardiopulmonary bypass
The Annals of Thoracic Surgery, 1992
To assess the safety and efficacy of concomitant pulmonary resection and cardiac operation requiring cardiopulmonary bypass, the records of 19 patients were reviewed. Eighteen patients (94.7%) presented with cardiac symptoms and were found to have pulmonary pathology of indeterminate etiology. Pulmonary resections were performed through a median sternotomy in all but 1 patient, who underwent posterolateral thoracotomy and right middle lobectomy after repositioning because dense adhesions prevented adequate dissection through the initial incision. A total of 24 resections were performed. Sixteen (66.7%) were performed on cardiopulmonary bypass. Six wedge resections (25.0%) were performed before bypass. Two lobectomies (8.3%) were performed after infusion of protamine sulfate. Nine patients (47.4%) had benign pathology, 7 (36.8%) had primary carcinoma, and 3 (15.8%) had metastatic disease. Bleeding complications occurred in 15.8% of patients (3/19). There was 1 perioperative death (5.3%), which was due to adult respiratory distress syndrome after intraoperative hemorrhage followed lobectomy for bullous disease. Another patient required lateral extension of the sternotomy during an episode of exsanguinating intraparenchymal pululmonary disease and cardiovascular disease have P several common risk factors. When they occur simultaneously in a patient, this creates a complex therapeutic challenge. Patients usually present with cardiac symptoms and are subsequently found to have pulmonary pathology. Less often, patients are found to have major cardiac pathology during evaluation for pulmonary resection [l].
Thoracoscopic anatomic lung resections for cancer in patients with previous cardiac surgery
Journal of Visualized Surgery, 2017
We reported the feasibility of thoracoscopic anatomical resections for lung cancer in four consecutive patients undergoing previous cardiac surgeries as coronary artery by-pass graft (CABG) using left internal mammary artery (LIMA) graft (n=1), cardiac transplantation (n=2), and mitral valve replacement (n=1). A three-port approach was used in all patients but one where an uniportal approach was adopted. Lobectomy was carried out in two patients; left upper three-segmentectomy and upper bilobectomy in the other two. All procedures were successfully performed without needing conversion. No intra-operative, post-operative morbidity and mortality were recorded. At last follow-up, all patients were alive without recurrence but one who had cerebral metastasis. Thoracoscopic lung resection after cardiac surgery is a feasible but complex procedure that should be performed in centres having a cardiac surgery team ready to operate in case of cardiac complications.
Should Cardiac Surgery and Lung Cancer Be Operated Simultaneously?
Kosuyolu Heart Journal
Introduction: There are limited studies regarding the concomitant surgical outcomes of resectable lung cancer (LC) and cardiac surgery (CS). This study aims to present the outcomes of cases with major pulmonary resection due to LC and CS that were operated upon simultaneously, and also present the literature associated with this procedure. Patients and Methods: From October 2011 to May 2019, 10 LC patients (8 men, 2 women) who had undergone concomitant CSs were included in the study. The median age of the patients was 67 years (43-78). All patients underwent sternotomy, with left thoracotomy added after sternotomy for 1 left lower lobe tumour. Cardiac operations were performed for coronary artery problems in 7 cases, for aorta stenosis of 1 case, for mitral stenosis for 1 case and for an intra-atrial mass in 1 case. Results: No mortality was observed in the early period. Re-operation linked to postoperative haemorrhage was not encountered. The most common complication was atrial fibrillation, which was seen in 3 cases. Nine cases underwent lobectomy, with 1 case undergoing bilobectomy. Four cases had adenocarcinoma, 2 cases had squamous cell carcinoma, 1 case had small cell carcinoma, 1 case had large cell carcinoma, 1 case had undifferentiated round cell carcinoma, and 1 case had atypical carcinoid tumour. The median duration of hospital stay was 5.5 days (4-10). Median follow-up was 74 months (1-91), with mortality observed in a total of 3 cases (30%); 2 due to recurrence and 1 due to cardiac arrest. Seven cases were tumour-free. Conclusion: When limited cases studies and previous literature were investigated, the concomitant LC and CS method was observed to result in the highest number of appropriate, reliable and satisfactory outcomes.
Surgical Treatment of Concomitant Severe Heart Disease and Lung Cancer
2021
The concomitant presentation of lung cancer and severe heart disease requiring intervention is a scenario that many clinicians have to face. Its common physiopathological substratum is unknown and it is believed that tobacco plays a role. From a surgical point of view, these patients pose various technical challenges and medical literature is scarce in providing solid answers. The aim of this report is to review our experience with cases undergoing combined surgical treatment of both heart disease and lung cancer, aiming to analyse patients' characteristics, operative technical considerations and related outcomes. A total of five patients were included, with two synchronous procedures, two cases with lung surgery being performed first and one case commenced with cardiac surgery. All cancers were non-small-cell lung carcinoma or carcinoid tumors and cardiac disease was mostly represented by severe aortic stenosis. Lobectomy was performed in two thirds of patients and minimally in...
European Journal of Cardio-Thoracic Surgery, 2008
The aim of this study was to analyze the early and long-term results of simultaneous surgical treatment of both coronary heart disease (CHD) and lung cancer. Twenty-five patients with the diagnoses of both non-small cell lung cancer (NSCLC) and unstable angina were operated on between 2001 and 2006 in the Department of Cardiothoracic Surgery at the University of Medical Sciences in Poznań, Poland. Myocardial revascularization was performed simultaneously with the lung resection. The mean patient age was 63 years. The majority (18 patients) were male and the stage of lung cancer was predominantly AJCC II. Most of the patients were classified as stage II or III CCS and the predominant pathology was a two-vessel disease. Fifteen lobectomies, six pneumonectomies and four wedge resections were performed together with the aortocoronary graft implantation (mean: 1.9 graft per patient). There were no postoperative deaths or perioperative myocardial infarctions (MI). The most frequent complications were as follows: atrial fibrillation (24%), atelectasis (12%) and residual pneumothorax (12%). All the patients were followed up for 8-60 months. Within this period, eight patients (32%) died, mostly due to the cancer relapse. The local recurrence of lung cancer and distant metastases were the only factors statistically influencing the late survival. No patient in the entire follow-up period had a MI. In three patients, the symptoms of recurrent angina occurred and one of them underwent a coronary stent implantation. Simultaneous off-pump myocardial revascularization and lung resection is a safe and effective treatment when unstable CHD and lung cancer coexist. In selected patients, this combined procedure may be an alternative to the two-stage approach, surgical or non-surgical (cardiologic) interventions preceding the pulmonary resection. The only statistically significant factor having an impact on long-term survival is the recurrence of the cancer.
Brazilian Journal of Cardiovascular Surgery
Introduction: Optimal surgical approach for the treatment of resectable lung cancer accompanied by coronary artery disease (CAD) remains a contentious issue. In this study, we present our cases that were operated simultaneously for concurrent lung cancer and CAD. Methods: Simultaneous off-pump coronary artery bypass surgery (OPCABG) and lung resection were performed on 10 patients in our clinic due to lung cancer accompanied by CAD. Demographic features of patients, operation data and postoperative results were evaluated retrospectively. Results: Mean patient age was 63.3 years (range 55-74). All patients were male. Six cases of squamous cell carcinoma, three of adenocarcinoma and one case of large cell carcinoma were diagnosed. Six patients had single-vessel CAD and 4 had two-vessel CAD. Three patients underwent OPCABG at first and then lung resection. The types of resections were one right pneumonectomy, three right upper lobectomies, one right lower lobectomy, three left upper lobectomies, and two left lower lobectomies. Reoperation was performed in one patient due to hemorrhage. One patient developed intraoperative contralateral tension pneumothorax. One patient died due to acute respiratory distress syndrome at the early postoperative period. Conclusion: Simultaneous surgery is a safe and reliable option in the treatment of selected patients with concurrent CAD and operable lung cancer.