Concomitant cardiac surgery and pulmonary resection

Surgical management of concomitant pulmonary and cardiac disease remains controversial. There is no consensus on the use of a one- or two-staged procedure, the timing of heparinization and the utilisation of cardio-pulmonary bypass.

We performed a retrospective review of 27 patients who underwent pulmonary and cardiac surgery, from 2000 to 2008, in two institutions. We focused on early postoperative morbidity and mortality.

24 men and 3 women, with a mean age of 68 years, were treated. Cardiac procedures consisted of coronary artery bypass grafting (n = 22), heart valve surgery (n = 3) or a combination of both (n = 2). Pulmonary resection included segmental resection (n = 1), lobectomy (n = 21), bilobectomy (n = 2) and pneumonectomy (n = 3). Histology of the pulmonary lesion was squamous cell carcinoma in 14 patients (52%), adenocarcinoma in 10 (37%), large cell neuroendocrine tumour in 1 (3%) and typical carcinoid in 1 (3%). The stage of the pulmonary malignancy was IA in 8 patients (31%), stage IB in 11 (42%), stage IIB in 5 (19%) and stage IIIB in 2 (8%). A benign lesion was found in 1 patient (3%). There was no in-hospital mortality. Postoperative complications occurred in 16 patients (59%) consisting of supraventricular arrhythmias in 11 (41%), pneumonia in 8 (30%), atelectasis in 6 (22%), ventricular arrhythmias in 2 (7%), pneumothorax in 1 (3%), pleural effusion in 1 (3%), and renal insufficiency in 1 patient (3%). Revision for bleeding was necessary in 3 patients (11%). The mean follow-up was 30,7 months with a median survival for all patients of 46 months.

Simultaneous procedures for cardiac disease and pulmonary lesions can be performed without life-threatening morbidity and no in-hospital mortality.