Cardiac operation with associated pulmonary resection

From February 1988 to May 1992, a total of 11 patients aged 52 to 81 years underwent concomitant cardiac operation and pulmonary resection for bronchogenic carcinoma at our institution. All pulmonary lesions were incidental findings on preoperative chest x-ray films. Diagnosis was obtained in six patients before resection. The operation was performed through a midline sternotomy with all patients requiring cardiopulmonary bypass. Pulmonary procedures included two wedge resections, seven lobectomies, and two double lobectomies. Seven patients underwent lobectomy while supported by bypass, with the lungs collapsed, during rewarming. Total bypass time for these patients averaged 143 minutes. Pathologic examination showed all lesions to be non-small-cell malignant tumors; four adenocarcinomas, four squamous cell carcinomas, two bronchoalveolar carcinomas, and one undifferentiated carcinoma. Nine were stage I and two were stage II. One of the wedge resections showed malignant disease involving the surgical margin that later required completion lobectomy. There were no operative deaths and no major postoperative complications. Postoperative hospital stays ranged from 6 to 17 days (mean 10 days) except for one patient who required a prolonged hospitalization because of a complication after thoracentesis on the side opposite the pulmonary resection. Concomitant cardiac operations with lobectomy can be safely performed during cardiopulmonary bypass without significantly prolonging pump time. Our observations suggest that concomitant cardiac surgery with pulmonary resection is a safe and effective technique with minimal morbidity and short hospital stay.