S. L. Hall1, K. Attwood1, A. Battoo1, E. Dexter1, M. Hennon1, M. Huang1, C. Nwogu1, S. Yendamuri1, T. Demmy1, A. Picone1 1Roswell Park Cancer Institute,Thoracic Surgery,Buffalo, NY, USA
Introduction:
Operating in the left pleural space after previous coronary artery bypass grafting (CABG), especially if the left internal mammary artery (LIMA) was used as a bypass conduit, entails risk due to possible injury to the conduit and myocardial infarction. Over the last decade, we have used VATS to improve visualization and adopted a strategy of leaving a sliver of lung on the graft in order to minimize conduit injury. In this study, we sought to assess the peri-operative outcomes of this strategy.
Methods:
All patients undergoing left sided thoracoscopic surgery from 1998 to 2016 at a single institution were reviewed. Perioperative morbidity and mortality, cancer staging, and long-term survival were compared between patients receiving (1) left-sided VATS with previous CABG, (2) right-sided VATS with previous CABG, and (3) thoracoscopy or thoracotomy with no history of previous CABG.
Results:
During the study period, 25 patients underwent left-sided thoracoscopic resection after CABG; 19 of the left upper lobe (LUL) and 6 of the left lower lobe (LLL). Of these patients, 19 (76%) had confirmed LIMA grafts. During this period, 27 patients underwent right sided resections after previous CABG and 1174 patients underwent lobectomy (VATS and Open) without previous CABG.
A comparison of pre-operative characteristics among the three groups demonstrated that patients with a history of CABG were older, more likely to be diabetic, more likely to be smokers, and have a greater prevalence of peripheral vascular disease and a history of congestive heart failure (Table 1). Surprisingly, patients having left sided resections also had a higher T stage and were more likely to have N1 disease (Table 1). Despite these characteristics, there were no significant differences in perioperative mortality (p=1.000), incidence of post-operative myocardial infarction (p=1.000), atrial fibrillation (p=0.208), conversion to thoracotomy (p=0.189), or pulmonary morbidities such as pneumonia (p=0.480) or prolonged air leak (p=0.817) between the comparison groups (Table 1). However, patients undergoing left sided resection were more likely to need a blood transfusion (p=0.010) when compared to the study groups, probably indicating the presence of extensive adhesions from previous surgery.
Conclusion:
Left sided thoracoscopic lung resection after CABG can be performed safely with perioperative outcomes approaching those without a history of CABG.
