Comparison of On-Pump or Off-Pump Coronary Artery Revascularization With Lung Resection

Schoenmakers, Micha C.J.; Boven, Wim-Jan van; Bosch, Jules van den; Swieten, Henry A. van

doi:10.1016/j.athoracsur.2007.04.005

Cited by 47 publications

(53 citation statements)

References 9 publications

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“…[8][9][10] It has been shown for instance that the activity of natural killer cells is inhibited by CPB and remains so in the immediate postoperative period. Schoenmakers and colleagues, 11) however, found no evidence that off-pump surgery is superior to on-pump in patients undergoing concomitant cardiac and pulmonary surgery. Dyszkiewicz et al and Ochi et al, 2,12) on the other hand, do cite benefits of off-pump coronary artery bypass grafting (OPCAB) with lung resection.…”

Section: Discussionmentioning

confidence: 99%

Early to Midterm Results of Cardiac Surgery with Concomitant Pulmonary Resection

Hosoba

Hanaoka

Suzuki

et al. 2012

ATCS

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Background: We report our experience of cardiac surgery with concomitant pulmonary resection, based on analysis of the results. Methods: Eleven patients (1 woman, 10 men) underwent cardiac surgery simultaneously with pulmonary resection; ten of them through median sternotomy. The cancer pathology consisted of non-small cell carcinoma (n = 10), and benign teratoma (n = 1). All lung lesions were removed using a wedge resection. Cardiac procedures consisted of off-pump coronary artery bypass grafting (n = 4), aortic valve replacement (n = 3), mitral valve plasty (n = 2), total arch replacement (n = 1), and descending aorta replacement (n = 1). Lung wedge resections were performed after induction with protamine sulfate. Results: The mean follow-up period was 19 ± 11 months (2-34). There was no operative mortality and no major cardiac complications. Three patients underwent a subsequent lobectomy through lateral thoracotomy. There were two postoperative deaths: one was from an unknown cause, 8 months postoperatively and another was from a lung cancer recurrence, 9 months after surgery. There were two local recurrences, 9 months and 14 months, postoperatively. The mean cancer-free period was 17 ± 10 (2-32) months. Conclusion: Rates of operative mortality and morbidity following cardiac surgery with concomitant pulmonary resection were favorable, and early to midterm results were acceptable. Keywords: lung cancer, concomitant cardiac surgery, wedge resection Ann Thorac Cardiovasc Surg 2012; 18: 8-11 doi: 10.5761/atcs.oa.11.01717 sequential and concomitant procedures, 1-4) the choice of which depends on the individual institution. Some institutions conduct a staged surgical procedure in which the cardiac surgery is mostly performed first followed by the lung surgery. Potential problems with this approach include delay in the lung resection due to the postoperative recovery phase and the additional cost of two operations. However, the concomitant procedure also has its shortcomings, such as the risk of dissemination due to manipulation of the pulmonary lobe, mechanical stress on the cardiac chambers, inability to perform radical lymph node dissection, and the risk of increasing the amount of blood loss due to the effect of heparinization.We studied a series of eleven patients who underwent concomitant pulmonary wedge resection and cardiac surgery. The aim of the study was to analyze the outcome of

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Section: Discussionmentioning

confidence: 99%

Early to Midterm Results of Cardiac Surgery with Concomitant Pulmonary Resection

Hosoba

Hanaoka

Suzuki

et al. 2012

ATCS

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“…Perioperative mortality and oncologic 5-year survival practically did not change, remaining at the level 0-6% and 9-86% respectively. As in our study, most operations [3,[10][11][12][13][14][15][16] were performed in one stage with the cardiac procedure followed by lung resection. Voets et al [3] compared one-stage versus two-stage procedures and concluded that there was no difference between the two groups regarding mortality; however, greater perioperative risk makes concomitant procedures less attractive.…”

Section: Discussionmentioning

confidence: 99%

“…Their study showed an immediate postoperative mortality between 0 and 6.7%, and 5-year survival for oncologic patients between 35% and 80%. More recently a number of nonrandomized studies [5,[6][7][8][9][10][11][12][13][14][15] have been published. In these studies (Table II) the results of 161 patients operated on in the years 1990-2011 were examined.…”

Section: Discussionmentioning

confidence: 99%

Cardiac surgery Long-term results after concomitant cardiac surgery and pulmonary resection

Kogan¹,

Rocah²,

Preisman³

et al. 2013

kitp

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StreszczenieWprowadzenie: Jednoczasowe zmiany chorobowe serca i płuc nie są częste, jednakże ich występowanie stanowi wyzwanie dla kardio-i torakochirurgów. Pacjenci z rakiem płuca i chorobą serca narażeni są w wysokim stopniu na pooperacyjną śmierć lub poważne powikłania sercowo-naczyniowe. Cel: Celem pracy było przedstawienie uzyskanych przez autorów wyników stosowania jednoczasowych operacji kardiochirurgicznych i resekcji płucnych. Materiał i metody: Od 1994 do 2012 roku 18 pacjentów z zaburzeniami sercowymi i rakiem płuc lub innymi chorobami płuc zostało poddanych operacji. 12 pacjentów przeszło pomostowanie aortalno-wieńcowe, 3 pacjentów przeszło wymianę zastawki aortalnej, a 3 pacjentów -inne zabiegi kardiochirurgiczne. Wykonano następujące resekcje płucne: pneumonektomię u 1 pacjenta, lobektomię u 6 pacjentów oraz resekcję klinową u 10 pacjentów. Zebrano dane dotyczące obserwacji wszystkich pacjentów (średni czas obserwacji: 70,6 miesięcy; zakres od 224 do 0,7 miesięcy). Wyniki: Badanie patologiczne potwierdziło obecność złośli-wych zmian płucnych u 12 pacjentów. Pięcioro pacjentów było operowanych ze względu na patologie nieonkologiczne, a u jednego pacjenta wykonano operacyjne zmniejszenie objętości płuc. Całkowite późne przeżycia wyniosły 88% i 67% odpowiednio dla przeżyć jednorocznych i 5-letnich. Wnioski: Wykonywanie operacji płucnych jednoczasowo z zabiegami kardiochirurgicznymi jest bezpieczne i skuteczne. Połączenie dwóch zabiegów pozwala na uniknięcie konieczności przeprowadzenia kolejnego poważnego zabiegu torakochirurgicznego i może owocować lepszymi wynikami klinicznymi. Słowa kluczowe: kardiochirurgia, torakochirurgia, jednoczasowe zabiegi chirurgiczne. CARDIAC SURGERY AbstractBackground: Concomitant lesions of the heart and lung are uncommon, but when present they pose a challenge for cardiac and thoracic surgeons. Patients with lung cancer and heart disease are at a high risk for postoperative death or severe cardiovascular complications. Aim of the study: To report our results of concomitant cardiac surgery and lung resection. Material and methods: From 1994 to 2012, 18 patients with cardiac disorders and lung cancer or another lung disease were operated on. Twelve patients underwent coronary artery bypass grafting, 3 patients underwent aortic valve replacement and 3 patients underwent another cardiac surgery procedure. The pulmonary resections consisted of pneumonectomy in 1 patient, lobectomy in 6 patients and wedge excision in 10 patients. Follow-up was obtained for all 18 patients (mean follow-up 70.6 months; range 224 to 0.7 months). Results: The pathologic examination confirmed lung malignancy in 12 patients. Five patients were operated on due to a non-oncologic pathology and 1 patient underwent lung volume resection. Overall late survival was 88% and 67% at 1 and 5 years, respectively. Conclusions: Lung resection carried out concomitantly with cardiac surgery is safe and effective. A combined procedure avoids the need for a second major thoracic procedure and may improve clinical o...

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“…In addition, cardiac surgery using cardiopulmonary bypass generally causes systemic tissue edema, which may increase the risk of failure of gastrointestinal tract anastomoses (13). A recent trend has been the use of off-pump CABG to avoid the effect of cardiopulmonary bypass and decrease the use of heparin (10,14,15). The off-pump technique could markedly lower the risk of the disadvantages related to use of cardiopulmonary bypass, although other studies found no advantage of using an off-pump technique compared with cardiac surgery using cardiopulmonary bypass (3,(13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

“…A recent trend has been the use of off-pump CABG to avoid the effect of cardiopulmonary bypass and decrease the use of heparin (10,14,15). The off-pump technique could markedly lower the risk of the disadvantages related to use of cardiopulmonary bypass, although other studies found no advantage of using an off-pump technique compared with cardiac surgery using cardiopulmonary bypass (3,(13)(14)(15). The present study demonstrated that concomitant OPCAB and non-cardiovascular surgery compared with those of isolated OPCAB did not increase operative mortality and perioperative morbidities, although the majority of patients had concomitant malignant disease and underwent laparotomy (63 patients had combined malignant diseases; 62 patients underwent general surgeries opening the abdominal cavity).…”

Section: Discussionmentioning

confidence: 99%

Concomitant off-pump coronary artery bypass and non-cardiovascular surgery

Han

Choi

et al. 2016

J. Thorac. Dis.

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Background: Reports on concomitant cardiac and non-cardiovascular surgeries have noted disadvantages in the use of extracorporeal circulation. We assessed the results of concomitant off-pump coronary artery bypass (OPCAB) and non-cardiovascular surgery, and compared them with isolated OPCAB results.Methods: Of 2,439 patients who underwent OPCAB between 1999 and 2014, 115 patients underwent concomitant OPCAB and non-cardiovascular surgery. Combined non-cardiovascular diseases included 63 malignant and 52 benign diseases. Concomitant non-cardiovascular surgeries performed were general (n=62), thoracic (n=47), orthopedic (n=3), urologic (n=2) and otolaryngologic surgeries (n=1). Operative results were compared between the OPCAB patients who underwent concomitant non-cardiovascular surgeries (group 1, n=115) and isolated OPCAB patients (group 2, n=2,251). Because preoperative characteristics of the two groups were different, a 1:2 propensity score-matched analysis was performed and operative results of the two matched groups were compared.Results: Operative mortality rates were 0.9% (1/115) in group 1 and 1.0% (22/2,251) in group 2 (P=0.909).Although there were differences in preoperative patient characteristics, postoperative complications, including atrial fibrillation (36.5% vs. 28.8%), perioperative myocardial infarction (MI) (4.3% vs. 5.2%), acute renal failure (1.7% vs. 4.9%), mediastinitis (0.9% vs. 0.8%), bleeding reoperation (0.9% vs. 2.9%), and respiratory complications (2.6% vs. 2.1%), did not show significant differences between the two groups.After a 1:2 propensity score-matched analysis, there were no statistical differences in operative complications between the two groups.Conclusions: Concomitant OPCAB and non-cardiovascular surgeries were not associated with increased mortality and postoperative morbidities when compared with isolated OPCAB.

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Comparison of On-Pump or Off-Pump Coronary Artery Revascularization With Lung Resection

Cited by 47 publications

References 9 publications

Early to Midterm Results of Cardiac Surgery with Concomitant Pulmonary Resection

Early to Midterm Results of Cardiac Surgery with Concomitant Pulmonary Resection

Cardiac surgery Long-term results after concomitant cardiac surgery and pulmonary resection

Concomitant off-pump coronary artery bypass and non-cardiovascular surgery

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