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Nandy K, Gangadhara B, Reddy S, Chakravarthy M, Jawali V, Thimmaiah SG, Khan A, Nayak SP. Simultaneous surgical management of malignancy and coronary heart disease. Indian J Thorac Cardiovasc Surg 2024; 40:433-439. [PMID: 38919194 PMCID: PMC11194229 DOI: 10.1007/s12055-023-01682-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 06/27/2024] Open
Abstract
Coronary heart disease and cancer are the most common causes of mortality across the globe. It has been a dilemma for the surgical team to decide which surgical procedure should be done first when a patient needs surgery for both. This is a single-center retrospective observational study. Six patients who underwent simultaneous coronary artery bypass graft (CABG) and oncological surgeries between January 2018 and July 2021 were included in the study. One patient underwent lung bilobectomy via the same sternotomy incision; one underwent surgery for breast cancer, stomach cancer, and colon cancer; and one patient each of buccal mucosa carcinoma and tongue carcinoma. The median age was 65 years (59-70). Median blood loss was 550 ml (400-800). The median intensive care unit (ICU) stay was 60 h (46-130) and hospital stay was 7.5 days (6-14). The median follow-up of the present study was 31.5 months (6-38). One patient with lung carcinoma developed recurrence after 6 months and the patient is in remission after a follow-up of 32 months. Simultaneous CABG and oncological resection can be performed effectively and safely by an experienced team of cardiothoracic surgeons, surgical oncologists, and anesthetists after good patient selection.
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Affiliation(s)
- Kunal Nandy
- Department of Surgical Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | - Bharath Gangadhara
- Department of Surgical Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | - Sreekanth Reddy
- Department of Surgical Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | - Murali Chakravarthy
- Department of Anaesthesia and Critical Care, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | - Vivek Jawali
- Department of Cardiothoracic Surgery, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | | | - Ameenuddin Khan
- Department of Surgical Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | - Sandeep Peraje Nayak
- Department of Surgical Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
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Huang C, Yang C, Huang J, Liao Q, Zhang X, Liao S. Combined one-stage minimally invasive surgery for primary pulmonary carcinoma and mitral regurgitation. J Cardiothorac Surg 2020; 15:31. [PMID: 32000846 PMCID: PMC6990509 DOI: 10.1186/s13019-020-1072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 01/22/2020] [Indexed: 11/29/2022] Open
Abstract
Background We report the first successful short-term outcome of one-stage minimally invasive surgery (MIS) mitral valve repair and video-assisted thoracoscopic surgery (VATS) lobectomy. Case presentation We report the first successful short-term outcome of combined one-stage video-assisted thoracoscopic surgery lobectomy and minimally invasive surgery in a patient with operable primary right upper lobe adenocarcinoma and mitral regurgitation. Post- operative recovery was uneventful, and follow-up at 6 weeks confirmed an excellent surgical and oncologic outcome. Conclusions We think one-stage minimally invasive surgery (MIS) cardiac surgery and video-assisted thoracoscopic surgery (VATS) lobectomy would benefit patients with satisfactory cardiac and pulmonary function.
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Affiliation(s)
- Chengfeng Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital , Jinan University, Guangzhou.No.613 Whampoa Avenue, Tianhe District, Guangzhou, China
| | - Chao Yang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiawen Huang
- Department of Pharmacy, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Qiuying Liao
- Department of Cardiovascular Surgery, The First Affiliated Hospital , Jinan University, Guangzhou.No.613 Whampoa Avenue, Tianhe District, Guangzhou, China
| | - Xiaoshen Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital , Jinan University, Guangzhou.No.613 Whampoa Avenue, Tianhe District, Guangzhou, China.
| | - Shengjie Liao
- Department of Cardiovascular Surgery, The First Affiliated Hospital , Jinan University, Guangzhou.No.613 Whampoa Avenue, Tianhe District, Guangzhou, China
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Li Z, Liu B, Ge W, Zhang W, Gu C, Liu J, Ke X, Zhang Y. Effect of simultaneous surgical treatment of severe coronary artery disease and lung cancer. J Int Med Res 2018; 47:591-599. [PMID: 30318969 PMCID: PMC6381511 DOI: 10.1177/0300060518805297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The co-incidence of lung cancer and coronary artery disease (CAD) is increasing in patients of advanced age. This study was performed to demonstrate the efficiency and safety of simultaneous coronary artery bypass grafting and lung cancer surgery in a selected group of older patients. Methods Twenty patients with severe CAD and coexisting lung cancer underwent simultaneous surgical interventions (Group A), and 20 patients with lung cancer underwent an isolated lung cancer operation (Group B). In Group A, the combined operations were carried out through 2 incisions in 3 patients, a single incision in 14 patients, and median sternotomy for heart surgery and thoracoscopic lobectomy for lung cancer in 3 patients. The single-incision approach was used in all patients in Group B. Results The operation time was longer and the blood loss volume was larger in Group A than B. No significant between-group differences were found in the 5-year relapse-free survival rate or 5-year survival rate. Conclusions The simultaneous performance of lung cancer surgery and cardiac surgery was effective and evidently safe in Group A. This treatment approach enabled earlier lung cancer resection and avoidance of the eventual complications associated with further surgical procedures.
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Affiliation(s)
- Zhi Li
- 1 Department of Cardiovascular Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University
| | - Ban Liu
- 2 Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine
| | - Wen Ge
- 3 Department of Cardiothoracic Surgery, Shuguang Hospital, affiliated to Shanghai University of TCM
| | - Wei Zhang
- 2 Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine
| | - Chang Gu
- 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Jingjing Liu
- 5 Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine
| | - Xianting Ke
- 5 Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine
| | - Yangyang Zhang
- 5 Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine.,6 Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
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Habal P, Šimek J, Lonský V, Novotný J. Possibilities of Combined Surgical Treatment of Lung Tumours and Heart Diseases. ACTA MEDICA (HRADEC KRALOVE, CZECH REPUBLIC) 2018. [DOI: 10.14712/18059694.2017.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The purpose of the study was a retrospective evaluation of the outcome of surgical therapy of lung cancer in patients where there was concomitant cardiac disease and who underwent a cardiac operation either because of ischemic heart disease or because of valvular disease. These patients were operated on at various time intervals (two to ten months) after their cardiac operation. Some patients had their lung cancer surgery after the cardiac operation because of the high risk of possible cardiac postoperative complications; in one patient the lung operation preceded the cardiac one.
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Liu B, Chen C, Gu C, Li Q, Liu J, Pu Y, Lin Y, Wei Z, Li Z, Zhang Y. Combined Coronary Artery Bypass Graft (CABG) Surgery and Lung Resection for Lung Cancer in Patients More than 50 Years-of-Age. Med Sci Monit 2018; 24:3307-3314. [PMID: 29779035 PMCID: PMC5989628 DOI: 10.12659/msm.907545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The co-existence of coronary heart disease (CHD) and lung cancer is increasing in an increasingly aging population. The aim of this study was to evaluate patient outcome from combined off-pump coronary artery bypass graft (CABG) surgery and lung resection in patients more than 50 years-of-age. Material/Methods A retrospective clinical study of 23 patients with a mean age of 70.2±8.4 years (range, 51–86 years) included 18 men and five women with CHD and lung cancer who underwent a single operation with combined off-pump CABG surgery and lung resection, for non-small cell lung cancer (NSCLC) (n=22) and small cell lung cancer (n=1). Surgical approaches included: median sternotomy in six patients; left lateral thoracotomy in nine patients; a median sternotomy in three patients; median sternotomy combined with thoracoscopic lobectomy in five patients. Results In the retrospective study of 23 patients, there were no deaths and no new cases of myocardial infarction (MI) in the immediate perioperative period. During the follow-up period, six patients died from lung cancer metastasis or recurrence; one patient died of acute renal failure; and one patient died from the effects of chemotherapy. The remaining 15 patients underwent postoperative follow-up for between 3–79 months with no deaths and no new cases of MI. Conclusions For patients who are more than 50 years-of-age and who have CHD and lung cancer, a single combined operation that includes off-pump CABG and lung resection can be safe and effective.
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Affiliation(s)
- Ban Liu
- Department of Cardiology, Shanghai Tenth Peoples' Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Chao Chen
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, Chile
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Qianfan Li
- Department of Cardiothoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jingjing Liu
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yiwei Pu
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Yu Lin
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zilun Wei
- The First Clinical Medical Department of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zhi Li
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Yangyang Zhang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Changes in cysteinyl leukotrienes during and after cardiac surgery with cardiopulmonary bypass in patients with and without chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg 2011; 141:1496-502.e3. [PMID: 21377695 DOI: 10.1016/j.jtcvs.2011.01.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 10/13/2010] [Accepted: 01/20/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pulmonary function frequently deteriorates after cardiopulmonary bypass (CPB). Chronic obstructive pulmonary disease (COPD) increases risk of respiratory complications after CPB. Cysteinyl leukotrienes are important mediators of respiratory dysfunction. Their role during cardiac surgery and its lung complications is incompletely understood. We studied whether production of cysteinyl leukotrienes changes during and after cardiac surgery with CPB and differs between patients with and without COPD. METHODS Patients with (n = 9) and without (n = 10) moderate-to-severe COPD undergoing cardiac surgery with CPB were prospectively included. Plasma and urinary cysteinyl leukotriene and leukotriene B(4) concentrations were measured by enzyme-linked immunosorbent assay after anesthesia induction, at end of CPB, after CPB, and 2 hours after intensive care unit admission. Gas exchange and respiratory mechanics were also assessed. RESULTS Patients with COPD had larger airway resistances after CPB and chest closure (P < .001), lower ratio of arterial Po(2) to inspired oxygen fraction at intensive care unit admission (215 ± 37 vs 328 ± 30 mm Hg, P < .05), and longer postoperative mechanical ventilation (13.7 ± 5.8 vs 6.8 ± 3.4 hours, P < .01). Urinary cysteinyl leukotriene concentrations increased with time in both groups (P < .01), but more in patients with than without COPD (P < .05). Plasma cysteinyl leukotriene concentrations increased significantly between baseline and intensive care unit admission in patients with but not without COPD (P < .01). Concentrations of leukotriene B(4) in plasma and urine did not increase significantly with time and were not different between groups. CONCLUSIONS Release of cysteinyl leukotrienes increases during cardiac surgery with CPB and is larger in patients with than without COPD. This may be related to higher lung and airway production of cysteinyl leukotrienes and neutrophil activation in patients with COPD.
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Sutton SW, Patel AN, Chase VA, Schmidt LA, Hunley EK, Yancey LW, Hebeler RF, Cheung EH, Henry AC, Meyers TP, Wood RE. Clinical benefits of continuous leukocyte filtration during cardiopulmonary bypass in patients undergoing valvular repair or replacement. Perfusion 2005; 20:21-9. [PMID: 15751667 DOI: 10.1191/0267659105pf781oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Valve operations in the form of repair or replacement make up a significant population of patients undergoing surgical procedures in the USA annually with the use of cardiopulmonary bypass. These patients experience a wide range of complications that are considered to be mediated by activation of complement and leukocytes. The extracorporeal perfusion circuit consists of multiple synthetic artificial surfaces. The biocompatibility of the blood contact surfaces is a variable that predisposes patients to an increased risk of complement mediation and activation. This can result in an inflammatory process, causing leukocytes to proliferate and sequester in the major organ systems. The purpose of this study was to determine whether filtration of activated leukocytes improved clinical outcomes following surgical intervention for valve repair or replacement. In this paper, we report a retrospective matched cohort study of 700 patients who underwent valve procedures from June 1999 to December 2002. The control group (CG) consisted of patients who had a conventional arterial line filter. In the study group (SG), patients had a conventional arterial line filter and a leukocyte arterial line filter (Pall Medical, NY). In the SG, blood diverted to the cardioplegia system was also leukocyte depleted to enhance myocardial preservation by adapting this device to the outflow port on the filter. Patient characteristics were similar for the SG and the CG, including 228 males and 122 females, mean age (62.4 versus 64.2 years), cardiopulmonary bypass time (127+/-64 versus 116+/-53 min), and aortic crossclamp time (84+/-23 versus 81+/-23 min). Our results demonstrate that the SG achieved statistically significant reduction in the time to extubation (p =0.03) and the number of patients with prolonged intubation in excess of 24 hours (p <0.04), in addition to improved postoperative oxygenation (p=0.01), and decreased length of hospital stay (p =0.03). We believe that leukocyte filters are clinically beneficial, as demonstrated by the results presented in this study.
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Affiliation(s)
- S W Sutton
- Baylor University Medical Center, Dallas, TX, USA.
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Hennein HA. Inflammation After Cardiopulmonary Bypass: Therapy for the Postpump Syndrome. Semin Cardiothorac Vasc Anesth 2001. [DOI: 10.1053/scva.2001.26129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiopulmonary bypass (CPB) is used in most, but not all, complex heart operations. CPB is associated with a systemic inflammatory response in adults and children. Many materials-dependent (exposure of blood to non- physiologic surfaces and conditions) and materials-in dependent (surgical trauma, ischemia-perfusion to the organs, changes in body temperature, and release of endotoxin) factors during CPB have been implicated in the etiology of this complex response. The mechanisms involved may include complement activation, release of cytokines, leukocyte activation with expression of ad hesion molecules, and production of various vasoactive and immunoactive substances. Postpump inflamma tion may lead to postoperative complications and may result in respiratory failure, renal dysfunction, bleeding disorders, neurologic dysfunction, altered liver func tion, and ultimately multiple organ failure. Significant efforts are being made to decrease the generation and effects of postpump inflammation. Interventions to this end have included avoiding CPB when possible, im proving the biocompatibility of the involved mechani cal devices, and administering medications that main tain cellular integrity. This article provides an overview of the etiology, pathophysiology, and treatment of postpump inflammation. Perhaps with additional in sight into this syndrome, CPB can be made a safer and more efficacious modality of cardiorespiratory support. Copyright© 2001 by W.B. Saunders Company.
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Affiliation(s)
- Hani A. Hennein
- Department of Pediatric Cardiothoracic Surgery, Loyola University Medical Center, 2160 South First Ave, Maywood, IL 60153
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