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COMBINED OFF-PUMP CORONARY ARTERY SURGERY AND LUNG RESECTION THROUGH THORACOTOMY

Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
Department of Cardiac Surgery, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032, Australia

We read with great interest the case report by Caimmi and co-workers (Combined minimally invasive coronary bypass surgery and left pulmonary lobectomy. Asian Cardiovasc Thorac Ann 2006;14:250–1[Abstract/Free Full Text] ). The authors describe the use of a limited left anterior thoracotomy for performance of left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) bypass off-pump with left upper lobectomy in two patients. We would like to share our experience with the authors on the combined multi vessel off-pump coronary artery bypass (OPCAB) and lung resection.¹ Our approach to this problem was the use of median sternotomy for OPCAB and lobectomy. We described the use of this technique in 6 patients including one patient who had OPCAB x 2 with left upper lobectomy and another patient where LITA was grafted to LAD and bilateral lung volume reduction surgery was performed. We agree with Caimmi et al that a combined procedure avoids a staged operation with delayed treatment of malignancy at second stage. Also avoidance of cardiopulmonary bypass (CPB) may be beneficial in the presence of pulmonary malignancy as it avoids immunosuppression with its hitherto undefined effects on the progression of malignant disease. We also found that this technique reduces post-operative blood loss and decreases duration of mechanical ventilation with a short intensive care unit (ICU) and hospital stay. Obviously to prove statistical significance, a larger cohort of patients is required.

We found that LITA harvesting is easier to perform through a median sternotomy in a conventional way. Skeletonised LITA was used in 5 of our cases where this conduit was used to graft LAD.

Moreover, we did multi vessel aortocoronary bypasses without any need for doing hybrid procedures using percutaneous coronary intervention (PCI). Both pleurae were opened widely following median sternotomy for assessment of lung cancer and for positioning the heart for various coronary anastomoses. The exposure of hilum was markedly improved by the division of inferior pulmonary ligament.

We revascularised the heart first, in contrast to the approach used by the authors. This ensures hemodynamic stability during pulmonary resection from positioning of the heart and from the fluid shifts during lung surgery. We congratulate the authors on their use of this useful and effective approach in this difficult clinical situation.

REFERENCES

1. Saxena P, Tam R. Combined off-pump bypass surgery and pulmonary resection. Ann Thorac Surg 2004;78:498–501.[Abstract/Free Full Text]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pankaj Saxena Robert Tam Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Saxena, P. Articles by Tam, R. Search for Related Content PubMed PubMed Citation Articles by Saxena, P. Articles by Tam, R. Related Collections Lung - other Minimally invasive surgery