Simultaneous nephrectomy and coronary artery bypass grafting through extended sternotomy

Abstract

BackgroundThe advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed simultaneous thoracic and abdominal operations to be made for cancer and concomitant severe heart vessel disease relieving the patient from several diseases simultaneously and achieving long lasting remission or cure.Clinical caseA simultaneous nephrectomy and coronary artery bypass grafting procedure through extended sternotomy is reported. A 63-year-old man with severe coronary artery disease was found to have renal carcinoma.DiagnosisPostoperative pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2. Coronarography revealed advanced three-vessel coronary artery disease.TreatmentWe successfully performed a simultaneous curative surgery for renal carcinoma and coronary artery bypass graft surgery under cardiopulmonary bypass using a novel technique of extended sternotomy. Simultaneous surgery thus appears to be a beneficial and safe approach for the treatment of coronary artery disease and resectable renal cancer in carefully selected patients.

Simultaneous Aortic Valve Replacement with Nephrectomy: A Case Report

“…6 We did not adopt the extended sternotomy technique (mid-sternotomy incision extended to subcostal incision) described by Budrikis et al, owing to the risk of spread of infection from abdominal cavity to chest cavity. 7 Renal protective measures taken during perioperative period included maintenance of euvolemia, avoidance of hemodilution, maintenance of hemodynamics (mean arterial pressure ≥ 65 mm Hg), maintenance of adequate flow and perfusion during CPB, limiting the duration of CPB, and avoidance of nephrotoxic agents (e.g., aminoglycosides, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, nonsteroidal anti-inflammatory agents, and contrast agents). Renal near-infrared spectroscopy monitoring would have probably been helpful for prediction of acute kidney injury caused by ischemia, but most studies related to this modality have been done on children.…”