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Video-assisted thoracic surgery (VATS) lobectomy after sternotomy for cardiac surgery increases risks. Conversion to thoracotomy may be needed due to adhesions, but techniques exist to minimize cardiac injury during VATS lung resection.

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Area of Science:

  • Thoracic Surgery
  • Cardiovascular Surgery
  • Pulmonary Medicine

Background:

  • Video-assisted thoracic surgery (VATS) lobectomy is standard for early-stage lung cancer.
  • Concerns exist about performing VATS after median sternotomy due to potential cardiac or bypass graft damage.
  • Limited data exists on VATS lobectomy following sternotomy for cardiac procedures.

Purpose of the Study:

  • To review a series of patients undergoing VATS anatomic resections after prior sternotomy for cardiac surgery.
  • To evaluate the safety and outcomes of VATS lobectomy in patients with a history of sternotomy.
  • To identify risks and potential complications associated with VATS after cardiac surgery.

Main Methods:

  • Retrospective review of 87 patients (88 pulmonary resections) between 1996 and 2010.
  • Patients had undergone prior sternotomy for coronary artery bypass grafting, valve surgery, or heart transplant.
  • Data collected on patient demographics, diagnoses, and surgical outcomes.

Main Results:

  • Operations after sternotomy were associated with higher mortality (5.7% vs 0.4%) and conversion to thoracotomy rates (15.9% vs 7%) compared to general VATS lobectomies.
  • Increased rates of myocardial infarction (2.3% vs 0.5%) and transfusion (13.6% vs 1.7%) were observed.
  • Specific injuries included the left main pulmonary artery and internal mammary artery graft in 1% of cases each.

Conclusions:

  • Prior sternotomy for cardiac surgery elevates the risks associated with VATS lobectomy.
  • Consideration for conversion to thoracotomy is advised when dense adhesions are encountered.
  • Techniques to mitigate cardiac risks during these procedures are discussed.