SESSION TITLE: Cardiothoracic Surgery Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Significant coronary artery disease is usually considered as a contraindication for lung transplantation (LTx). A surgical technique of concomitant off-pump lung transplant and coronary artery bypass grafting (CABG) is described.
METHODS: Patient 1. 64-year-old man with interstitial lung disease, asbestosis andcoronary artery disease. LAS: 94.9. Off-pump bilateral sequential LTx and an off-pump two-vessel CABG through bilateral antero-axillary thoracotomies. The left internal mammary artery was harvested through the left thoracotomy. After left pneumonectomy, a saphenous vein graft was anastomosed to the descending aorta under side-biting clamp. A left off-pump LTx followed by off-pump anastomosis of the saphenous vein graft to the obtuse marginal branch was performed. A right off-pump LTx was then performed. Lastly, off-pump anastomosis of the left internal mammary artery-left anterior descending coronary artery anastomosis was performed. The ischemic time was 261 minutes for the left lung and 424 minutes for the right lung. Patient 2. 63-year-old man with interstitial lung disease, mantle radiation to his mediastinum for Hodgkin lymphoma, and left main coronary artery disease. LAS: 35.7. Off-pump single left LTx and an off-pump two-vessel CABG through a left antero-axillary thoracotomy. After the left pneumonectomy, a saphenous vein graft was anastomosed to the descending aorta. An off-pump left LTx, followed by off-pump anastomoses of the saphenous vein graft to the ramus intermedius and sequentially to the left anterior descending coronary artery was performed. The ischemic time was 236 minutes.
RESULTS: Patient 1 was extubated on postoperative day (POD) 3 and was discharged home on POD 18. At 6-month follow up, he is doing well with FVC: 2.59 liters (59%) and FEV 1 1.52 Liters (46%). Patient 2 was extubated on POD 1 and was discharged home on POD 22. Postoperative CT angiography showed widely patent grafts (Figure 1). At 4-year follow up, he is doing well with FVC 2.77 liters (65%) and FEV1 2.42 liters (82%).
CONCLUSIONS: Combined off-pump LTx and multi-vessel off-pump CABG through minimally invasive approach is technically feasible, and can provide excellent outcomes for this sick patient population.
CLINICAL IMPLICATIONS: Novel surgical technique is described to perform concomitant lung transplant and coronary artery bypass through minimally invasive approach. Lung transplant surgeons can learn to improve their surgical skills.
DISCLOSURE: The following authors have nothing to disclose: Yoshiya Toyoda, Norihisa Shigemura, Akira Shiose
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