Surgical management of a simultaneous aortic valve replacement and pneumonectomy (original) (raw)

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.

The literature concerning heart surgery after pneumonectomy is still poor. Moreover, there is still a lack of a standardized approach to such a patient in the decision-making process. Here, we report a case of a patient who had previously had left pneumonectomy for malignancy and who had coronary artery disease and mitral and tricuspid regurgitation treated with a hybrid procedure.

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...

Severe aortic stenosis (AS) with reduced left ventricular systolic function and pulmonary artery hypertension (PH) is associated with poor outcome if remained untreated We report a case report of a 62 years old male patient weighing 69 kg had progressive dyspnea for 5 years and was diagnosed cardiac patient, and was scheduled for an urgent aortic valve replacement. He had severely reduced left ventricular (LV) function and severe pulmonary hypertension. The patient was put on bypass with special emphasis on myocardial protection. Tissue valve was placed and patient was successfully put off cardiopulmonary bypass on high inotrope score, which was tapered after some time. The patient was shifted to CICU after chest closure and was extubated on fast track mode. The patient was followed up for three months showing improvement in symptoms and LV function The objective of reporting the case is to highlight the role of multidisciplinary integrated approach in the perioperative period for best patient outcome. ABSTRACT Citation: Akhtar MI, Butt S, Shahabuddin S, Hamid M. Urgent aortic valve replacement in severe aortic stenosis with severe left ventricular dysfunction and severe pulmonary hypertension: a perioperative multidisciplinary management approach. Anaesth Pain & Intensive Care 2017;21(3):366-369