Simultaneous minimally invasive coronary artery bypass grafting and lung resection.

Abstract

The best surgical treatment strategy for coexisting coronary artery disease and lung cancer remains controversial. This study analyzed the safety and efficacy of a simultaneous minimally invasive procedure for patients with coronary artery disease and lung cancer. Patients who underwent simultaneous minimally invasive off-pump coronary artery bypass grafting and lung resection from January 2016 to December 2021 were retrospectively analyzed. The procedure was performed in the fourth intercostal space through a small left anterolateral mini-thoracotomy. Harvesting of the left internal thoracic artery (LIMA) and sewing of the anastomoses were performed under direct vision. Lung resections were performed with or without the assistance of a thoracoscope. Sixteen patients were included with a mean age of 67.13±10.61 years. Procedural success occurred in all patients with a mean operative time of 366.88±94.48 min. All patients received at least one coronary artery bypass LIMA graft. Pneumonectomy, lobectomy, segment resection, and wedge resection were performed in 1 (6.25%), 8 (50%), 2 (12.5%) and 5 (31.25%) patients, respectively. There were no perioperative deaths or new myocardial infarctions. Complications included 1 case of postoperative bleeding, 2 lung infections, 2 cases of atelectasis, 1 case of pleural effusion and 1 case of cardiac arrhythmia. All the patients were followed up for 1-57 months, cancer recurrence occurred in 2 patients, and one patient died. The remaining patients showed no evidence of tumor recurrence or myocardial infarction. Simultaneous minimally invasive procedure is safe and effective for select patients with coronary artery disease and lung cancer.