Combined lung volume reduction and coronary artery bypass surgery

Purpose: Patients with end-stage lung disease that have significant coronary artery disease (CAD) are not candidates for lung transplantation. Because early results of lung volume reduction surgery (LVRS) have been encouraging, we considered these patients for combined LVRS and coronary artery bypass grafting (CABG). Methods: Accordingly, 10 patients with steroid-dependent COPD that required oxygen at rest were found to have significant asymptomatic CAD with preserved biventricular function during lung transplant evaluation. There were eight men and two women with a median age of 55 years (range, 51-59). Seven patients had significant proximal lesions (<60% diameter) of all three coronary arteries and three patients had significant lesions of the left main and right coronary arteries. Preoperatively, each patient completed a pulmonary rehabilitation program. Each patient first underwent standard CABC with reversed saphenous vein grans and aprotinin. Median number of vessels bypassed was 3.0 and bypass time was 58 minutes. Bilateral LVRS was performed after reversal of heparin using mechanical staplers, bovine pericardial strips, and single lung ventilation. Results: Nine of ten patients were extubated within 12 hours. Median hospital stay was 10 days (range, 7-21). One patient required elective cardioversion for atrial fibrillation. There were no other complications and no deaths. At six months of follow-up, all patients were off oxygen and bad significant improvement in pulmonary function and quality of life. Values are median and percent predicted; *=p<0.05. (TLC - total lung capacity, RV - residual volume, WOB - work of breathing) Preop 6 mos Preop 6 mos FEV1(L) 0.6 (24) 1.2 (43)* WOB (J/L) 1.5 0.8* FVC (L) 2.3 (71) 3.2 (99)* O₂(mmHg) 54 74* TLC(L) 7.6 (139) 6.1 (104)* CO₂(mmHg) 48 42* RV(L) 5.5 (293) 3.8 (192)* 6 min walk (ft) 945 1395* Conclusion: We conclude that combined LVRS and CABG can be performed safely with low morbidity and mortality in very selected patients. Early results suggest that this combined approach may prove to be an accepted treatment modality in patients with COPD who are not lung transplant candidates due to severe CAD.