Comparison of on-pump or off-pump coronary artery revascularization with lung resection

The simultaneous occurrence of coronary artery disease and lung cancer is rare. The best surgical treatment strategy remains controversial: performing a combined procedure with or without the use of extracorporeal circulation (ECC). The aim of this study was to compare the surgical procedure, postoperative complications, and survival of combined surgery with the use of ECC to combined surgery without ECC.

Forty-three patients underwent a combined procedure between 1994 and 2005. Twenty-eight patients (25 male and 3 female; mean age, 66 years; range, 54 to 76 years) underwent coronary artery (CA) revascularization with ECC after the lung resection was carried out (on-pump). Fifteen patients (14 male and 1 female; mean age, 71 years; range, 50 to 79 years) had first CA revascularization without ECC followed by lung resection (off-pump). Survival was estimated by the Kaplan-Meier method and analyzed using the log-rank test and the Cox proportional hazard regression model.

Postoperative complications and hospital survival were not significantly different between groups. However, in the on-pump group late survival was significantly better. Late survival was significantly longer in patients without recurrent vessel disease and with stage I lung cancer.

These results show no significant difference in using an on-pump or off-pump technique to perform a combined cardiac and lung surgery in relation to postoperative complications and hospital survival. However, our data show a significantly longer late survival period in the on-pump group. Because the off-pump patients were older and had more advanced lung malignancy, the off-pump technique should be continued and evaluated.