Left upper lobectomy after coronary artery bypass grafting

Abstract

Left upper lobectomy after CABG, in patients with previous CABG and LIMA grafting, is safe. Usually the entire lung can be safely mobilized off the bypass grafts; if needed, a small sliver of lung can be left on the grafts. A curative resection is possible with minimal perioperative cardiac morbidity, and excellent 30- and 90-day mortality.

The use of three-dimensional imaging for R0 resection of a left upper lobe adenocarcinoma after coronary artery bypass surgery

“…Previous LITA harvest and LAD anastomosis increase the complexity of the operation due to adhesion formation, putting the graft at risk. 1 , 2 , 3 The presence of a LITA to LAD bypass graft, however, should not preclude surgical treatment for resectable lung cancer in an operable patient. 1 , 2 This case highlights the importance of preoperative planning for completion of a complex lung resection using advanced imaging techniques and a robotic-assisted surgical approach.…”

The patent internal thoracic artery graft: Increased degree of difficulty for left-sided pulmonary resections

“…Depending on the size and location of the tumor, a patent left internal thoracic artery (LITA) to coronary artery bypass graft (CABG) can be technically intimidating to a thoracic surgeon hoping for an R0 resection with a left upper lobectomy. Dr Wei and colleagues 1 at the University of Alabama are to be congratulated for their description and excellent results on successfully completing anatomic lung cancer resections of the left upper lobe in 28 patients who previously underwent CABG with LITA grafts. In fact, the surgical literature implies that we are batting 1000 when it comes to safety and effectiveness in this situation, even if the operations are performed with lessinvasive techniques, such as video-assisted thoracic surgery or the surgical robot.…”

“…In fact, the surgical literature implies that we are batting 1000 when it comes to safety and effectiveness in this situation, even if the operations are performed with lessinvasive techniques, such as video-assisted thoracic surgery or the surgical robot. [1][2][3] Furthermore, the authors are so confident in their technical ability to safely dissect the lung off the LITA that they perform their operations without an arterial line, central venous access, or a Foley catheter, not that those things necessarily would be life saving should the surgeon acutely disrupt a LITA to left anterior descending graft with the potential for acute cardiac ischemia and ventricular fibrillation.…”