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Open heart operation after pneumonectomy

B Medalion1, A Elami, E Milgalter

  • 1Department of Cardiothoracic Surgery, Hadassah University Hospital, Jerusalem, Israel.

The Annals of Thoracic Surgery
|September 1, 1994
PubMed
Summary
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Coronary artery bypass grafting is feasible in patients with prior left pneumonectomy. Careful preoperative, intraoperative, and postoperative management ensures acceptable outcomes for these complex cardiac surgeries.

Area of Science:

  • Cardiothoracic Surgery
  • Cardiac Surgery
  • Pulmonary Surgery

Background:

  • Coronary artery bypass grafting (CABG) in patients with a history of pneumonectomy presents unique surgical challenges.
  • Left pneumonectomy significantly alters thoracic anatomy, potentially complicating cardiac procedures.

Observation:

  • A case review of 27 patients who underwent CABG after left pneumonectomy was conducted.
  • Data were gathered from a single successful case, literature review, and a global surgeon survey.
  • Perioperative mortality was 7.4% (2/27), with morbidities including pneumothorax (3/27) and pleural effusion (1/27).

Findings:

  • Exposure of circumflex marginal branches was difficult in 2 patients post-left pneumonectomy.
  • Despite anatomical challenges, successful CABG was achieved in the majority of reviewed cases.

Related Experiment Videos

  • Overall operative mortality and morbidity were deemed acceptable with meticulous management.

    • Implications:

    • Open-heart procedures, including CABG, can be safely performed in patients with prior pneumonectomy.
    • Tailored preoperative, intraoperative, and postoperative strategies are crucial for successful outcomes.
    • This study supports the consideration of CABG in select pneumonectomy survivors with coronary artery disease.