Lung Transplantation and Concomitant Coronary Artery Bypass Grafting Does Not Impair Patient Outcomes: Insights from a Single-Center Experience

Abstract

<h3>Purpose</h3> Prevalence of pretransplant significant (stenosis >70%) coronary artery disease (sCAD) has increased in lung transplant recipients. SCAD can be treated with percutaneous coronary angioplasty and stenting (PTCA) before transplantation or with coronary artery bypass grafting (CABG), that is preferred in patients with left main stenosis or three vessels disease, and in patients whose impaired lung function does not allow the time required for dual anti-aggregation. This study presents our experience with concomitant lung transplantation and CABG for sCAD. <h3>Methods</h3> Records of lung-transplanted patients between 01/2010 and 10/2021 were retrospectively reviewed. Patients with pretransplant sCAD were included, and outcomes compared between lung-transplanted patients undergoing concomitant CABG (CABG group) vs. patients undergoing sole lung transplantation (lung alone group). CABG using saphenous vein grafts was performed soon after lung transplantation, on ECMO (beating heart technique) support or on cardiopulmonary bypass (CPB) with cardioplegic arrest. Median (IQR) follow-up was 39 (11-77) months. <h3>Results</h3> During the study period, among the 1367 lung-transplanted patients, 84 (6%) patients showed sCAD; 22 (26%) patients formed the CABG group (single, n=6, two, n=6, and three, n=10 vessel CAD) and 62 (74%) formed the lung alone group (pretransplant PTCA, n=47; CABG, n=7; conservative therapy, n=8). Pretransplant characteristics did not differ between groups. A bilateral thoraco-sternotomy was performed in all CABG patients. CABG (1 bypass, n=9; 2 bypasses, n=12; 3 bypasses, n=1) was performed on beating heart technique in 15 patients and with cardioplegic arrest in 7 patients. Prevalence of primary graft dysfunction grade 3 at 72 hours (9% vs. 2%, p=0.17), revision for bleeding (9% vs. 11%, p=0.56), dialysis (5% vs. 11%, p=0.33), in-hospital mortality (0% vs. 5%, p=0.56), and median mechanical ventilation (16 vs. 12 hours, p=0.65), intensive care unit (2 vs. 2 days, p=0.09) and hospital stay (23 vs. 23 days, p=0.77) times did not differ in CABG vs. lung alone group. At 1 and 5 years, graft survival (%) did not differ in CABG vs. lung alone group (94 vs. 84, 74 vs. 61 p=0.70). <h3>Conclusion</h3> Concomitant CABG and lung transplantation does not impair posttransplant course, and is an alternative to pretransplant PTCA.