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J Thorac Cardiovasc Surg 2005;130:859-863
© 2005 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Outcome of lung transplantation for patients requiring concomitant cardiac surgery

^a University of Iowa Hospital and Clinics, Resident Department of Cardiothoracic Surgery, Iowa City, Iowa
^b Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
^c Division of Pulmonary Medicine and Critical Care, Department of Internal Medicine, Washington University School of Medicine, St Louis, Mo

Read at the Twenty-third Annual Meeting of The International Society of Heart and Lung Transplantation, San Francisco, Calif, 2004.

Received for publication December 8, 2004; revisions received May 2, 2005; accepted for publication May 9, 2005.

^_* Address for reprints: Nader Moazami, MD, Washington University School of Medicine, Barnes-Jewish Hospital, 660 S Euclid Ave, Campus Box 8234, St. Louis, MO 63110 (Email: moazamin{at}wustl.edu).

BACKGROUND: The clinical results of lung transplantation and concomitant cardiac surgery are unclear. The effect of cardiopulmonary bypass on the pulmonary allograft is controversial, and the effect of cardiac arrest and cardiac surgery in this setting is unknown. Our aim was to review the operative results and long-term survival in this group of patients.

METHODS: A retrospective review of all lung transplantations between 1988 and 2003 was performed. Patients who had concomitant cardiac surgery during lung transplantation were compared with those who underwent lung transplantation alone. The variables analyzed included allograft ischemic times, use of cardiopulmonary bypass, early graft dysfunction, postoperative morbidity, survival, length of mechanical ventilation, length of stay in the intensive care unit, and overall hospital stay.

RESULTS: During this period, 35 of 700 lung transplant recipients (15 single and 20 bilateral transplantations) underwent concomitant cardiac surgery. The cardiac procedures were for patent foramen ovale (n = 18), atrial septal defect (n = 9), ventricular septal defect (n = 2), coronary bypass (n = 4), and "other" (n = 2). Allograft ischemic time, use of extracorporeal membrane oxygenation, length of hospital stay, operative mortality, and survival were not significantly different between the 2 groups. Ventilator time and intensive care unit stay were longer in the cardiac surgery group.

CONCLUSIONS: Cardiac surgery at the time of lung transplantation can be performed with acceptable morbidity and mortality. The immediate and long-term survival in these patients is similar to that of other lung transplant recipients. Lung transplantation should continue to be offered to patients with normal ventricular function who require concomitant limited cardiac surgery.

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