Prior and Perioperative Revascularization Impact on Survival in Lung Transplant Patients

Abstract

<h3>Purpose</h3> Survival outcomes of lung transplant recipients with concomitant coronary artery disease who had prior or perioperative revascularization remains a topic of conversation. We hypothesized concomitant-CABG can be a safe and viable option during lung transplantation in a select group of patients. <h3>Methods</h3> A retrospective analysis of all single and double lung transplant patients from Feb-2012 to Aug-2021 (n=868) was performed. Patients were split into 4 groups: (1) those who received a preoperative percutaneous coronary intervention (n=58), (2) those who received pre-operative coronary artery bypass grafting (CABG) (n=39), (3) those who received concomitant CABG during transplantation (n=51), and (4) those who had lung transplantation without revascularization (n=720). Groups were compared for demographics, surgical procedure, and survival outcomes using STATA Inc. P-value <0.05 was considered significant. <h3>Results</h3> Throughout all groups, a majority of patients receiving LTx were males (p<0.01) and ethnically white (p<0.01). The no revascularization group was significantly younger than the other groups (p<0.01). The diagnosis of IPF constituted the largest portion of all groups except the no revascularization group (p<0.01). In terms of transplant type, the pre-CABG group had a higher portion of single LTx procedures (p=0.014). The antero-axillary thoracotamy approach was the most utilized approach in all groups except Con-CABG (p=0.014). Kaplan-Meier analysis showed that survival rates post-LTx were not significantly different between the groups (p=0.471). Cox Regression analysis showed diagnosis significantly impacted survival rates (p=0.009). <h3>Conclusion</h3> These results continue to suggest that preoperative or intraoperative revascularization did not affect survival outcomes in lung transplant patients. Select patients with coronary artery disease may benefit when intervened during lung transplant procedure with similar outcomes to patients without intervention.