Abstract
The object of the study: coronary revascularization in patients with malignant lung diseases and concomitant ischemic heart disease. The problem to be solved: selection of the optimal tactics for coronary bypass grafting simultaneously with lung resections. Main scientific results: an individual approach to the choice of tactics for carrying out simultaneous operations in patients with malignant lung diseases and concomitant ischemic heart disease is proposed. It has been shown that performing coronary artery bypass grafting simultaneously with lung resections, according to the proposed methods, allows minimizing surgical trauma and eliminating the influence of additional risk factors associated with cardiopulmonary bypass (CPB). The area of practical use of research results: surgical hospitals. An innovative technological product: methods for performing simultaneous coronary (artery) bypass grafting in patients with malignant lung diseases, based on the use of sternotomy, thoracotomy and mini-thoracotomy approaches. The area of application of an innovative technological product: clinical practice of performing simultaneous operations for combined pathology of the heart and lungs in medical institutions of a general surgical profile.
Highlights
It has been shown that performing coronary artery bypass grafting simultaneously with lung resections, according to the proposed methods, allows minimizing surgical trauma and eliminating the influence of additional risk factors associated with cardiopulmonary bypass (CPB)
An innovative technological product: methods for performing simultaneous coronary bypass grafting in patients with malignant lung diseases, based on the use of sternotomy, thoracotomy and mini-thoracotomy approaches
Performing off-pump coronary artery bypass grafting (CABG) simultaneously with lung resection can be widely used in clinical practice, such decisions should be made jointly by cardiologists, cardiac surgeons and thoracic surgeons based on a specific clinical situation, with the obligatory consideration of the patient’s characteristics and with his participation
Summary
According to the summary literature data, the incidence of a combination of oncological and cardiovascular diseases ranges from 0.2 to 28 % [1], and the incidence of a combination of lung cancer and coronary heart disease (CHD) is about 7 %, while manifestations of CHD that do not allow perform radical surgery, are detected in 10 % of patients with lung cancer [2].The presence of concomitant CHD in cancer patients is often a contraindication to surgical treatment of tumors; it limits the severity of interventions, or changes the type of treatment in favor of polychemotherapy or radiation therapy [3].Antecedent myocardial revascularization is an effective method for preventing hospital complications and hospital mortality due to cardiac causes [4].1. 1. The need for aggressive antiplatelet therapy in patients after angioplasty and stenting of the coronary arteries increases the risk of massive bleeding during organ resection operations with regional lymph node dissection for the tumor [4] and limits their use. Simultaneous or staged coronary artery bypass grafting (CABG) in patients with major lung tumors and concomitant CHD with a high perioperative risk of cardiac complications (>5 %) is the most optimal way to solve the problem [4]. According to the literature of recent years, the prospects are indicated in the use of CABG techniques without CPB and using minimally invasive approaches, which makes it possible to reduce cardiovascular injuries in patients with oncology, in the case of performing a single-stage operation, as well as using staged tactics [7]. The algorithms for simultaneous and staged operations are still controversial: the number of surgical approaches, the procedure for performing individual stages of operations, the best terms for the interstage period [2, 8]
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