Abstract
Combined coronary artery bypass grafting (CABG) and lung transplantation (LT) remains controversial. We sought to examine the operative course and clinical outcomes of patients who underwent concomitant CABG and LT at our center.
We conducted a retrospective analysis of all patients who underwent concomitant CABG and LT between May, 2014 and September, 2022. The primary outcome was survival. Secondary outcomes included serious postoperative complications and length of hospital stay (LOS).
A total of 40 patients were included in the analysis. Mean age was 66 years (IQR 50-78) and 88% of the patients were male. All patients had either underlying interstitial lung disease (92%) or chronic obstructive lung disease (8%). The mean LAS score was 54.7 (IQR 32.9-93.6); 11 (27%) patients were hospitalized at the time of LT; and 2 (5%) required ECMO as a bridge to LT. All CABG procedures were performed with a beating heart, off-pump, using endoscopically harvested saphenous vein grafts. Of the 5 patients who required circulatory support during LT, modalities included cardiopulmonary bypass (n=3) and ECMO (n=2). More than half of all patients (n=22; 55%) required bypass of ≥ 2 vessels. Survival did not differ between number of vessels bypassed; however, 1-year survival was statistically higher among patients that received bypass of the left anterior descending artery compared to those that did not (Figure 1). Complication rates were low with 3 (7.5%) patients requiring dialysis, 1 (2%) suffering from a stroke, and 3 (7.5%) requiring return to the operating room for bleeding. The median LOS was 18 days (IQR 7-70). Survival to discharge was 98%, 30-day survival was 100%, and 1-year survival was 81% (26/31).
Concomitant off-pump CABG using vein grafts at the time of LT can be performed with acceptable outcomes at high-volume LT centers. However, long-term survival among patients with non-left anterior descending coronary artery disease may be reduced.