Lung Transplant Survival Regarding Past and Concomitant Cardiac Revascularization

Abstract

<h3>Purpose</h3> Coronary artery disease (CAD) is not uncommon among lung transplant (LTx) and has been often carefully evaluated before LTx. Those who undergo these pre- and or post-lung transplantation percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) procedures may be at risk to LTx short-term mortality. The survival outcome of prior or perioperative revascularization has not been adequately established. <h3>Methods</h3> A single-center retrospective analysis of all single and double LTx patients from Feb-2012 to Mar-2020 (n=748) was performed. Patients were split into 4 groups: (1) patients who received a preoperative PCI (Pre-PCI) (n=55), (2) those who received preoperative CABG (Pre-CABG) (n=38), (3) those who received concomitant CABG during LTx (Con-CABG) (n=47), (4) those who had LTx with no need for revascularization (n=607). Groups were compared for demographics, surgical procedure, and survival outcomes using STATA Inc. P-value <0.05 was considered significant. <h3>Results</h3> The no revascularization group was statistically younger than the rest (P<0.0001). The lung allocation score was significantly lower in the no revascularization group (P=0.03). All groups were predominantly diagnosed with idiopathic pulmonary fibrosis. The proportion of patients with chronic obstructive pulmonary disease (COPD) was greatest in the group not requiring revascularization (P<0.0001). Length of stay and transplant type were similar among all groups (LOS P=0.758; Tx-type P=0.212). Of the concomitant-CABG patients, 24 patients needed more than 1 graft (mean, 1.7 ± 0.99 grafts). Posttransplant survival outcomes among all groups were similar (P=0.551), however were significantly affected by diagnosis' "other" than COPD or IPF (P=0.003). <h3>Conclusion</h3> Our results suggest that preoperative or intraoperative revascularization did not affect survival outcomes in lung transplant patients. Selected patients with coronary artery disease may benefit when intervened during lung transplant procedure.