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Right arrow Lung - transplantation
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J Thorac Cardiovasc Surg 2002;124:1250-1251
© 2002 The American Association for Thoracic Surgery

Brief Communications

Concomitant coronary artery revascularization to allow successful lung transplantation in selected patients with coronary artery disease

Richard Lee, MD, Bryan F. Meyers, MD, Thoralf M. Sundt, MD, Elbert P. Trulock, MD, G. Alexander Patterson, MD St Louis, Mo

From the Division of Cardiothoracic Surgery, Washington University, St Louis, Mo.

Received for publication Nov 27, 2001. Accepted for publication March 25, 2002. Address for reprints: G. Alexander Patterson, MD, One Barnes-Jewish Hospital Plaza, Suite 3108, Queeny Tower, St Louis, MO 63110 (E-mail: pattersona@msnotes.wustl.edu).

The first 20% of the full text of this article appears below.

Coronary artery disease has previously been considered an absolute contraindication to lung transplantation. Because of the scarcity of lung donors and a desire for the best organ utilization, patients with coronary artery disease were previously considered a prohibitive surgical risk. In addition, the potential adverse impact of coronary artery disease on the midterm survival after lung transplantation has excluded these patients from consideration for transplantation. However, several risk factors common to both end-stage lung and cardiac disease, most notably cigarette smoking and obesity, lead to a substantial incidence of coronary artery disease in potential lung recipients.Go 1 Descriptions of successful coronary artery bypass beforeGo 2 and afterGo 3 lung transplantation have led some groups to perform coronary artery bypass at the time of lung transplantation with the assistance of cardiopulmonary bypass in a small number of highly selected patients.Go Go 4,5 Recently, a case of combined coronary artery bypass and bilateral lung transplantation with off-pump techniques has been described.Go 6 Here we describe 4 cases of combined lung transplantation and coronary bypass grafting: 2 with the assistance of cardiopulmonary bypass and 2 without.

Clinical summaries

Patient 1
A 54-year-old man with a 22-pack-y history of smoking had end-stage lung disease from idiopathic pulmonary fibrosis. Preoperative cardiac catheterization revealed an 80% mid circumflex lesion but normal left ventricular function. An attempt at angioplasty was unsuccessful. After 2 years on the waiting list and substantial weight loss, the patient underwent right single-lung transplantation and coronary artery bypass to the first and second obtuse marginal branches of the circumflex coronary artery. The procedure was performed under cardiopulmonary bypass through a median sternotomy with a single sequential saphenous . . . [Full Text of this Article]




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