Concomitant Heart and Lung Surgery During Lung Transplantation

Area of Science:

• Cardiothoracic Surgery
• Transplantation Medicine
• Surgical Outcomes Research

Background:

• Limited data exists on outcomes of combined cardiac and lung surgery during lung transplantation (LTx).
• While cardiac surgery during LTx shows no significant impact, concomitant lung surgery (CLS) data is scarce.
• This study investigates survival outcomes comparing LTx with concomitant cardiac surgery (CCS), CLS, and no concomitant surgeries.

Purpose of the Study:

• To compare survival outcomes of lung transplantation (LTx) with concomitant cardiac surgery (CCS) versus concomitant lung surgery (CLS).
• To evaluate the impact of concurrent thoracic surgical procedures on LTx patient survival.
• To inform clinical decision-making for patients requiring complex thoracic interventions during LTx.

Main Methods:

• Retrospective analysis of 1099 single and double LTx patients from March 2012 to June 2023.
• Stratification into three groups: CCS, CLS, and no concomitant surgery.
• Survival analysis using Kaplan-Meier curves, log-rank tests, and Cox proportional hazard models.

Main Results:

• No significant differences in survival rates were observed between LTx with CCS, CLS, or no concomitant surgery (P=0.849).
• Concomitant surgery groups, particularly CLS, showed significantly longer hospital stays and higher lung allocation scores.
• Mortality risk did not differ significantly between CCS or CLS groups compared to those without concomitant surgery.

Conclusions:

• Lung transplantation with concomitant cardiac or lung surgery yields similar survival outcomes to LTx alone.
• LTx can effectively address concurrent thoracic surgical needs, such as coronary revascularization or lung volume reduction.
• These findings support the integrated approach to managing complex thoracic conditions during LTx, potentially optimizing patient management.