[General thoracic surgery for patients with coronary artery or aortic disease]

The incidence of thoracic surgery for patients with arteriosclerosis has increased with the aging of society. Pulmonary resection is generally indicated for patients with coronary artery or aortic disease, following careful preoperative evaluations of cardiopulmonary function and oncological resectability. When preoperative coronary revascularization is required, percutaneous coronary intervention with a bare metal stent might be effective, due to the intermission of antiplatelet therapy during surgery. Furthermore, a" non-dissecting" technique that preserves mediastinal adhesion and divides the lung parenchyma is an option for pulmonary resection in patients who previously underwent coronary arterial bypass grafting (CABG) using the ipsilateral internal thoracic artery. Perioperative analgesic management with epidural anesthesia is quite important to stabilize hemodynamics and avoid the use of nonsteroidal anti-inflammatory drugs, which may influence potential renal dysfunction. Postoperative arterial fibrillation, which reduces blood flow in the coronary artery with low cardiac output, can be predicted based on preoperative serum brain natriuretic peptide level, and prevented by prophylactic atrial natriuretic peptide infusion and immediately controlled with an ultrashort-acting beta-blocker. Thus, special attention is required for surgical interventions that include pulmonary resection in patients with coronary artery or aortic disease.