Successful combined bilateral lung volume reduction and coronary artery bypass grafting surgery: Implications and advantages

Abstract

DISCUSSIONLVRS has been shown to improve the QOL, respiratory physiology, and survival in highly selected patients. 1,2 Significant cardiac comorbidity is generally considered a contraindication to LVRS. Untreated symptomatic severe aortic stenosis, however, is associated with a poor prognosis. 3 In contrast, patients who undergo successful AVR for symptomatic aortic stenosis experience a significant survival benefit. 3 Appropriate case selection allied with careful perioperative planning in this case resulted in QOL, functional, pulmonary, and prognostic benefits. A multidisciplinary approach was essential in providing an optimal outcome. A skilled anesthetist was required to ensure proper placement of the epidural catheter and double-lumen endotracheal tube and intraoperative management of the patient. An error in any of these areas could potentially lead to severe consequences. The epidural catheter was placed 4 hours before scheduled surgery, as this strategy has been shown to be safe despite full anticoagulation for CPB. 4 A satisfactory postoperative thoracic epidural analgesia contributed to the patient's good compliance with physiotherapy and breathing exercises, thereby reducing the risks of postoperative sputum retention and chest infection. Careful anesthetic and intensive care management allowed for maintenance of cardiorespiratory stability and a successful planned early extubation, thereby minimizing the risks associated with mechanical ventilation. Daily medical management by the chest physicians in the perioperative period also ensured that the patient received optimal medical therapy for her emphysema.