Prior and Perioperative Revascularization Does Not Affect Survival in Lung Transplant Patients

Abstract

Coronary artery disease is common in lung transplant patients and has historically been viewed as a contraindication to the procedure. Although this mindset is changing, the effect of prior or perioperative revascularization on lung transplant survival outcomes is not adequately established. We performed a single-center retrospective analysis of all single and double lung transplant patients from 2012 to 2018 (n= 468). Patients were split into 4 groups: (1) patients who received a preoperative percutaneous coronary intervention (n= 34), (2) those who received coronary artery bypass grafting (CABG) before transplantation (n= 25), (3) those that received concomitant CABG during transplantation (n= 29), and (4) those who had lung transplantation with no need for revascularization (n= 380). Groups were compared for demographics, surgical procedure, and survival outcomes. The no-revascularization group was statistically younger than the rest (P= .001). The lung allocation score trended toward being higher in the concomitant coronary artery bypass group (P= .03). All groups were predominantly diagnosed with idiopathic pulmonary fibrosis. The proportion of patients with chronic obstructive pulmonary disease was greatest in the group not requiring revascularization (P= .001). Patients with previous CABG were more likely to receive a single lung transplant than a double one (21 versus 4; P= .054). Length of stay, posttransplant survival, and postoperative adverse events were similar among all groups. Results suggest that preoperative or intraoperative revascularization does not negatively affect survival in lung transplant patients; lung recipients with coronary artery disease have comparable survival when adequately revascularized.