Off-pump coronary artery bypass surgery in patients with coronary artery disease and malign neoplasia: results of ten patients and review of the literature

Abstract

Cardiopulmonary bypass has been reported to have many effects on the immune system. The aim of this study was to investigate the efficiency and usefulness of off-pump coronary artery bypass (OPCAB) surgery on patients who had coronary artery disease besides malign neoplasia. We applied OPCAB operations to 217 patients between March 2001 and April 2004, ten of whom had malign neoplasia. These patients were diagnosed to have coronary artery disease on their routine examination for their oncologic operation. The malignancies were stomach cancer (2 patients), colon-rectum carcinoma (3 patients), breast carcinoma (2 patients), surrenal carcinoma (1 patient), larynx carcinoma (1 patient), and meningioma (1 patient). The patients were operated on for their neoplasia by the related clinics at a mean of 42 days after the OPCAB surgery. The patients were discharged with surgical success and without any cardiac complications. Coronary artery bypass surgery before a noncardiac major operation may effectively decrease the long-term mortality due to myocardial ischemia. Severe coronary artery disease should be surgically treated in those patients who are scheduled to undergo an operation for malign neoplasia. Extracorporeal circulation impairs the immune system and negatively affects the defense of host against malignancy. Therefore, patients with severe coronary artery disease who are candidates for oncologic operation should be treated with OPCAB.

Cancer in Heart Disease Patients: What are the Limitations in the Treatment strategy?

“…CD4 + helper cells and, hence, the CD4 + /CD8 + NK cells showed an increase in the first week after heart surgery [63]. Others found a decrease in NK cell activity [8,15,17]. This suppression was also observed after stress and surgical intervention, and could promote tumor dissemination.…”

“…In patients with early gastric cancer, gastrectomy could be performed once the patient has recovered from CABG [16]. Mediastinitis is a possible complication after a one-stage procedure and should be taken into account, especially when the digestive tract must be opened [16,17].…”

“…n Thoracotomy at a later date; n Second surgical trauma; n Delay in treating the malignancy; n Postoperative pain; n Pulmonary dysfunction and atelectasis; n Bleeding and need for transfusion; n Cardiac and renal complications; n Stress and anxiety; n And reducing costs and stay in hospital or intensive care unit [3,5,16,17,27].…”

“…CABG and cancer surgery can be performed simultaneously as a one-or two-stage procedure. If a two-stage procedure is preferred, a recovery of 4-6 weeks should be anticipated [14][15][16][17]. If the tumor is aggressive or rapidly growing, this might compromise longterm survival because a potentially curable disease could become incurable.…”

Open Heart Surgery with Intracranial Meningioma: Case Report & Literature Review

“…We postulate that these inflammatory mediators may result in peri-tumour oedema in previously asymptomatic meningiomas especially those of secretory type and thus lead to the onset of neurological deficit after open-heart surgery. Various therapeutic options to counteract systemic inflammatory reaction may be considered more aggressively in patients with pre-existing meningiomas; including the option of off-pump, beating heart coronary artery surgery and hybrid procedures [17,18].…”