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Coronary Artery Bypass Graft and/or Valvular Operations Following Prior Pneumonectomy^*

Report of Four New Patients and Review of the Literature

^* From the Departments of Pulmonary, Allergy, and Critical Care Medicine (Dr. Stoller) and Thoracic and Cardiovascular Surgery (Drs. Blackstone, Pettersson, and Mihaljevic), Cleveland Clinic, Cleveland, OH.

Correspondence to: James K. Stoller, MD, MS, FCCP, Department of Pulmonary, Allergy and Critical Care Medicine, A90, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: stollej{at}ccf.org

Abstract

Background: The reported experience is sparse for patients with prior pneumonectomy who are undergoing surgery for ischemic or valvular heart disease. Such surgery poses special technical challenges. To expand the experience with this challenging clinical intervention, we reviewed the reported patients with prior pneumonectomy who were undergoing cardiac surgery as well as the experience at the Cleveland Clinic.

Methods: A MEDLINE search of the literature for articles published in the English language from 1966 to August 2006 was conducted using the search terms "pneumonectomy" and "cardiac surgery." We included all available individually described patients and also reviewed the Cardiovascular Information Registry at the Cleveland Clinic from 1972 to 2006.

Results: A total of 19 individually described patients in 13 reports were available, 15 of which had previously been reported and 4 that were newly reported from our institution (1 of whom had undergone two operations separated by 8 years). Of the 20 operations performed in these 19 patients, coronary artery bypass grafting (CABG) alone was performed in 15 patients (75%), valve replacement or repair was performed in 4 patients (20%), and CABG with both aortic valve replacement and mitral valve repair was performed in 1 patient (5%). Most patients (13; 68%) had undergone left pneumonectomy. For these 19 patients, the postoperative mortality rate was 16%. Postoperative complications followed 10 of the operations (50%).

Conclusions: Although complications and postoperative deaths occurred more frequently than in other high-risk patient groups (eg, those with COPD undergoing cardiac surgery), this experience suggests that cardiac surgery can be undertaken with a reasonable likelihood of a favorable outcome in this challenging population, justifying the approach in appropriately selected and counseled patients.

Key Words: cardiac surgery • coronary artery bypass graft • outcomes • pneumonectomy • valve repair