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Ann Thorac Surg 2004;77:1023-1027
© 2004 The Society of Thoracic Surgeons

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Original article: general thoracic

Simultaneous lung resection for cancer and myocardial revascularization without cardiopulmonary bypass (off-pump coronary artery bypass grafting)

Wojciech Dyszkiewicz, MD, PhD^a, Marek M. Jemielity, MD, PhD^b, Cezary T. Piwkowski, MD^a*, Bartomiej Perek, MD^b, Mariusz Kasprzyk, MD^b

^a Thoracic Surgery, Karol Marcinkowski University of Medical Sciences, Pozna, Poland
^b Cardiac Surgery, Karol Marcinkowski University of Medical Sciences, Pozna, Poland

Accepted for publication July 21, 2003.

^* Address reprint requests to Dr Piwkowski, Department of Thoracic Surgery, Karol Marcinkowski University of Medical Sciences, Szamarzewski st. 62, 60-569 Pozna, Poland
e-mail: cezary_p{at}hotmail.com

BACKROUND: Patients with resectable lung cancer and unstable coronary heart disease are at high risk of postoperative death or severe cardiovascular complications. The aim of this study was to present the early results of radical lung resection for cancer with simultaneous myocardial revascularization on the beating heart (off-pump coronary artery bypass [OPCAB]).

METHODS: From 1999 to 2002, thirteen patients (9 men and 4 women, aged 54 to 71 years, mean age 64 yrs) with resectable lung cancer and unstable angina or a recent history of myocardial infarction, were operated on. All of them underwent coronary angiography and neither coronary angioplasty nor stenting were feasible. Eight lobectomies, three pneumonectomies, and two wedge resections were carried out together with aortocoronary graft implantation (mean number of grafts: 1.7 per patient). Myocardial revascularization without cardiopulmonary bypass (OPCAB) preceded the lung resections. The preferred approach to the heart and lung was by sternotomy.

RESULTS: There were no postoperative deaths in this group of patients. The most frequent postoperative complication was prolonged air leakage and one patient required respiratory support for two days. In one patient, significant blood loss was observed with a need for rethoracotomy. Transient supraventricular cardiac arrhythmias occurred in three patients. None of the patients showed evidence of myocardial ischemia after surgery. Patients were followed up for 7 to 36 months. None had acute myocardial infarction. In one patient, who underwent lobectomy, local recurrence was found. In another patient, who underwent pneumonectomy, distant metastases occurred in the third year of observation.

CONCLUSIONS: Lung resection carried out simultaneously with OPCAB is a safe and effective method for the treatment of lung cancer and myocardial ischemia.

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