Simultaneous Minimally Invasive Coronary Artery Bypass Grafting and Lung Resection

Abstract

Background The best surgical treatment strategy for coexisting coronary artery disease (CAD) and lung cancer (LC) remains controversial. This study analyzed the safety and efficacy of a simultaneous minimally invasive procedure for patients with CAD and LC.

Methods Patients who underwent simultaneous minimally invasive off-pump coronary artery bypass grafting and lung resection from January 2016 to December 2021 were retrospectively analyzed. The procedure was performed in the fourth intercostal space through a small left anterolateral minithoracotomy. Harvesting of the left internal mammary artery (LIMA) and sewing of the anastomoses were performed under direct vision. Lung resections were performed with or without the assistance of a thoracoscope.

Results Sixteen patients were included with a mean age of 67.13 ± 10.61 years. Procedural success occurred in all patients with a mean operative time of 366.88 ± 94.48 minutes. All patients received at least one coronary artery bypass LIMA graft. Pneumonectomy, lobectomy, segment resection, and wedge resection were performed in one (6.25%), eight (50%), two (12.5%), and five (31.25%) patients, respectively. There were no perioperative deaths or new myocardial infarctions. Complications included one case of postoperative bleeding, two lung infections, two cases of atelectasis, one case of pleural effusion, and one case of cardiac arrhythmia. All the patients were followed up for 1 to 57 months, cancer recurrence occurred in two patients, and one patient died. The remaining patients showed no evidence of tumor recurrence or myocardial infarction.

Conclusion This simultaneous minimally invasive procedure is safe and effective for selected patients with CAD and LC.

Keywords

coronary artery bypass grafting - lung cancer - treatment - minimally invasive - surgery - complications - thoracoscopy

Publication History

Received: 18 June 2023

Accepted: 28 September 2023

Accepted Manuscript online:
29 September 2023

Article published online:
15 November 2023

• References

• 1 Virani SS, Alonso A, Aparicio HJ. et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2021 Update: a report from the American Heart Association. Circulation 2021; 143 (08) e254-e743
• 2 Timmis A, Townsend N, Gale CP. et al; European Society of Cardiology. European Society of Cardiology: cardiovascular disease statistics 2019. Eur Heart J 2020; 41 (01) 12-85
• 3 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (03) 209-249
• 4 Ciriaco P, Carretta A, Calori G, Mazzone P, Zannini P. Lung resection for cancer in patients with coronary arterial disease: analysis of short-term results. Eur J Cardiothorac Surg 2002; 22 (01) 35-40
• 5 Kozower BD, Sheng S, O'Brien SM. et al. STS database risk models: predictors of mortality and major morbidity for lung cancer resection. Ann Thorac Surg 2010; 90 (03) 875-881 , discussion 881–883
• 6 Voets AJ, Joesoef KS, van Teeffelen ME. Synchroneously occurring lung cancer (stages I-II) and coronary artery disease: concomitant versus staged surgical approach. Eur J Cardiothorac Surg 1997; 12 (05) 713-717
• 7 Yeginsu A, Vayvada M, Karademir BC. et al. Combined off-pump coronary artery bypass grafting and lung resection in patients with lung cancer accompanied by coronary artery disease. Rev Bras Cir Cardiovasc 2018; 33 (05) 483-489
• 8 Dyszkiewicz W, Jemielity M, Piwkowski C. et al. The early and late results of combined off-pump coronary artery bypass grafting and pulmonary resection in patients with concomitant lung cancer and unstable coronary heart disease. Eur J Cardiothorac Surg 2008; 34 (03) 531-535
• 9 Ma X, Huang F, Zhang Z, Song F, Ou S. Lung cancer resection with concurrent off-pump coronary artery bypasses: safety and efficiency. J Thorac Dis 2016; 8 (08) 2038-2045
• 10 Brunelli A, Cassivi SD, Fibla J. et al. External validation of the recalibrated thoracic revised cardiac risk index for predicting the risk of major cardiac complications after lung resection. Ann Thorac Surg 2011; 92 (02) 445-448
• 11 Ferguson MK, Celauro AD, Vigneswaran WT. Validation of a modified scoring system for cardiovascular risk associated with major lung resection. Eur J Cardiothorac Surg 2012; 41 (03) 598-602
• 12 Li X, Fu Y, Miao J, Li H, Hu B. Video-assisted thoracoscopic lobectomy after percutaneous coronary intervention in lung cancer patients with concomitant coronary heart disease. Thorac Cancer 2017; 8 (05) 477-481
• 13 Yun T, Tang Y, Yang B. et al. Comparison of perioperative characteristics and prognostic performance in patients with pulmonary lobectomy in early or later period after percutaneous coronary intervention. Transl Cancer Res 2019; 8 (05) 2073-2078
• 14 Lawton JS, Tamis-Holland JE, Bangalore S. et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145 (03) e4-e17
• 15 Head SJ, Milojevic M, Daemen J. et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet 2018; 391 (10124): 939-948
• 16 Chassot PG, Delabays A, Spahn DR. Preoperative evaluation of patients with, or at risk of, coronary artery disease undergoing non-cardiac surgery. Br J Anaesth 2002; 89 (05) 747-759
• 17 Fernandez FG, Crabtree TD, Liu J, Meyers BF. Incremental risk of prior coronary arterial stents for pulmonary resection. Ann Thorac Surg 2013; 95 (04) 1212-1218 , discussion 1219–1220
• 18 Doenst T, Haverich A, Serruys P. et al. PCI and CABG for treating stable coronary artery disease: JACC review topic of the week. J Am Coll Cardiol 2019; 73 (08) 964-976
• 19 Tourmousoglou CE, Apostolakis E, Dougenis D. Simultaneous occurrence of coronary artery disease and lung cancer: what is the best surgical treatment strategy?. Interact Cardiovasc Thorac Surg 2014; 19 (04) 673-681
• 20 Patanè F, Verzini A, Zingarelli E, di Summa M. Simultaneous operation for cardiac disease and lung cancer. Interact Cardiovasc Thorac Surg 2002; 1 (02) 69-71
• 21 Powell B, Bolton WD. Management of lung cancer with concomitant cardiac disease. Thorac Surg Clin 2018; 28 (01) 69-79
• 22 Cheng S, Jiang Y, Li X, Lu X, Zhang X, Sun D. Perioperative outcomes of combined heart surgery and lung tumor resection: a systematic review and meta-analysis. J Cardiothorac Surg 2021; 16 (01) 227
• 23 Kauffmann M, Krüger T, Aebert H. Surgery on extracorporeal circulation in early and advanced non-small cell lung cancer. Thorac Cardiovasc Surg 2013; 61 (02) 103-108
• 24 Dickes MS, Stammers AH, Pierce ML. et al. Outcome analysis of coronary artery bypass grafting: minimally invasive versus standard techniques. Perfusion 1999; 14 (06) 461-472
• 25 Xu Y, Li Y, Bao W, Qiu S. MIDCAB versus off-pump CABG: comparative study. Hellenic J Cardiol 2020; 61 (02) 120-124
• 26 Holzhey DM, Jacobs S, Mochalski M. et al. Minimally invasive hybrid coronary artery revascularization. Ann Thorac Surg 2008; 86 (06) 1856-1860
• 27 Repossini A, Di Bacco L, Nicoli F. et al. Minimally invasive coronary artery bypass: twenty-year experience. J Thorac Cardiovasc Surg 2019; 158 (01) 127-138.e1