Simultaneous Minimally Invasive Coronary Artery Bypass Grafting and Lung Resection

Abstract

Background: The best surgical treatment strategy for coexisting coronary artery disease and lung cancer remains controversial. This study analyzed the safety and efficacy of a simultaneous minimally invasive procedure for patients with coronary artery disease and lung cancer. Methods: Patients who underwent simultaneous minimally invasive off-pump coronary artery bypass grafting and lung resection from January 2016 to December 2021 were retrospectively analyzed. The procedure was performed in the fourth intercostal space through a small left anterolateral mini-thoracotomy. Harvesting of the left internal thoracic artery (LIMA) and sewing of the anastomoses were performed under direct vision. Lung resections were performed with or without the assistance of a thoracoscope. Results: Sixteen patients were included with a mean age of 67.13±10.61 years. Procedural success occurred in all patients with a mean operative time of 366.88±94.48 min. All patients received at least one coronary artery bypass LIMA graft. Pneumonectomy, lobectomy, segment resection, and wedge resection were performed in 1 (6.25%), 8 (50%), 2 (12.5%) and 5 (31.25%) patients, respectively. There were no perioperative deaths or new myocardial infarctions. Complications included 1 case of postoperative bleeding, 2 lung infections, 2 cases of atelectasis, 1 case of pleural effusion and 1 case of cardiac arrhythmia. All the patients were followed up for 1-57 months, cancer recurrence occurred in 2 patients, and one patient died. The remaining patients showed no evidence of tumor recurrence or myocardial infarction. Conclusions: Simultaneous minimally invasive procedure is safe and effective for select patients with coronary artery disease and lung cancer.