RESULTS OF COMBINED PULMONARY RESECTION AND CARDIAC OPERATION

Background. Concomitant lesions of the heart and lung are uncommon, bu t when present they pose a therapeutic challenge for thoracic surgeons . A combined procedure avoids the need for a second major thoracic pro cedure and may improve outcomes and provide economic benefit. However, cardiopulmonary bypass may adversely affect the natural history of pu lmonary malignancies. Methods. The clinical records of 30 patients wer e reviewed who underwent simultaneous lung resection and cardiac opera tions between January 1982 and July 1995. Follow-up was obtained on al l 30 patients (mean follow-up, 22 months; range, 1 to 100 months). Res ults. Twenty-four patients underwent coronary artery bypass grafting i n conjunction with pulmonary resection. Six patients underwent aortic (n = 4) or mitral (n = 2) valve replacement, The pulmonary resections consisted of pneumonectomy (n = 3), lobectomy (n = 14), wedge excision (n = 12), and tracheal resection (n = 1). Twenty-one patients had pat hologic findings that confirmed adenocarcinoma (n = 10), squamous cell carcinoma (n = 5), small cell carcinoma (n = 2), or other malignancy (n = 4). Tumor stage of primary lung cancers was stage I, n = 12; stag e II, n = 3; and stage IIIa, n = 2. Pathologic examination revealed be nign disease in 9 patients. There were two operative deaths, one due t o aspiration and one due to stroke, There were three late deaths, two cardiac and one of metastatic disease. Overall late survival was 85% /- 7% and 73% +/- 16% at 1 and 5 years, respectively. Actuarial surviv al for patients with malignant disease was 64% at 5 years. Conclusions . Simultaneous cardiac operation and lung resection was not associated with increased early or late morbidity or mortality. Cardiopulmonary bypass does not adversely affect survival in patients with malignant d isease. Cardiac valve replacement can be performed safely in conjuncti on with pulmonary resection.