Single- Versus Multi-Vessel Coronary Artery Bypass Grafting During Lung Transplantation

Concomitant coronary artery bypass grafting (CABG) during lung transplantation is feasible for select patients, yet the effect of the number of bypass grafts and extent of revascularization on outcomes has yet to be investigated. This study evaluates whether multivessel CABG is associated with differences in short- and long-term survival compared to single-vessel CABG.

We conducted a retrospective cohort study of 78 patients who underwent concomitant CABG with lung transplantation at a single center from 2012 to 2025. Patients were grouped by number of CABGs: single (n = 43) versus multiple (n = 35). Kaplan-Meier curves and log-rank tests were used to compare survival between groups. A Cox proportional hazards model assessed five-y mortality.

Baseline characteristics, such as age, body mass index, and lung allocation score, were similar between multivessel and single-vessel CABG cohorts. Median sternotomy was more common in multivessel CABG (71.4% versus 30.2%, P < 0.001). Early mortality was similar in both groups: 30 d (2.9% versus 0%, P = 0.268) and 90 d (8.6% versus 2.3%, P = 0.208). Five-year survival was 52.4% for multivessel versus 39.3% for single-vessel CABG (P = 0.220). Cox modeling demonstrated that multivessel CABG was not associated with increased mortality (hazard ratio 0.77, 95% confidence interval 0.42-1.43, P = 0.415).

Multivessel CABG during lung transplantation can be performed safely without compromising short- or long-term survival compared to single-vessel CABG, supporting the feasibility of extensive revascularization in appropriately selected patients.