M. Hamms1, M. A. Kashem2, B. O’Murchu4, R. Bashir4, J. Gomez-Abraham2, S. Keshavamurthy2, E. Leotta2, T. Yoshizumi2, K. Shenoy3, A. J. Mamary3, G. Criner3, F. Cordova3, Y. Toyoda2,3 1Temple University Hospital,Philadelpha, PA, USA 2Temple University,Cardiovascular Surgery,Philadelpha, PA, USA 3Temple University,Division Of Thoracic And Pulmonary Medicine,Philadelpha, PA, USA 4Temple University,Section Of Cardiology,Philadelphia, PA, USA
Introduction: Significant coronary artery disease is a relative contraindication for lung transplantation. However, recent single center studies suggest concomitant coronary artery bypass grafting (CABG) can be performed at the time of lung transplantation. The purpose of this study was to show our excellent outcomes with these concomitant procedures, and to describe our surgical techniques.
Methods: Retrospective review for 240 consecutive lung transplants performed during March, 2012 to August, 2016, was conducted. Lung Transplantation with CABG (n=17) and without CABG (n=223) was compared for statistical significance using SAS Inc.
Results:
The recipient age was significantly (p=0.009) higher, 66 ± 5 (range 52-74) years in lung transplant with CABG vs. 62 ± 10 (range 21-78) years in Lung transplant without CABG whereas the lung allocation score (60 ± 21 vs. 53± 21), and the donor age (35 ± 10 vs. 33 ± 11 years) were similar, respectively.
All CABGs (bypass grafts=1-3) were performed on a beating heart without cardioplegic cardiac arrest, with off pump (n=7), with cardiopulmonary bypass (n=7), and with veno-arterial extracorporeal membrane oxygenation (n=3). On pump vs. off pump was determined based on the need to safely perform lung transplant portion.
Surgical approaches were determined based on the surgical exposure to the lung and coronary arteries, consisting from median sternotomy (n=7), anterior thoracotomy (n=7) and clamshell (n=3).
When the left anterior descending coronary artery required revascularization, the left internal mammary artery (LIMA) was used in 92% (11 out of 12 patients). The LIMA was harvested through median sternotomy (n=6) or left anterior thoracotomy (n=5).
When the saphenous vein grafts were used (n=15), the inflow was the ascending aorta (n=12), the descending aorta (n=2) and the LIMA (n=1).
The median hospital stay was similar with lung transplant with CABG (18 days) vs. lung transplant without CABG (18 days).
Two patients died after concomitant lung transplantation and CABG on postoperative day No. 414 and 642 both due to infection, resulting in 100% 1-year survival and 80% 3-year survival rates whereas lung transplantation without CABG had 85% and 76%, respectively (p=0.397).
Conclusion:Excellent outcomes can be achieved in lung transplantation along with concomitant CABG by carefully conducted surgical strategies including off pump vs. on pump, a variety of surgical approaches, and choice of conduits.
