[Simultaneous cardiac and thoracic operations].
BACKGROUND
Optimal surgical strategy in patients with combined disease of heart (mainly ischemic heart disease or critical valve disease) and other thoracic organs (mainly pulmonary carcinoma) is still controversial.


METHODS
From 1997 to 2004, 13 simultaneous cardiac and thoracic operations were performed in 13 patients. Most of them were necessary for combinations of symptomatic coronary artery disease (CAD) and bronchogenic carcinoma (BCA).


METHODS
11 patients showed CAD, mean preoperative LVEF was 44 %.


METHODS
Surgical exposure was performed via sternotomy in 10 patients, the rest of the patients underwent thoracotomy. Seven patients were operated on cardiopulmonary bypass, the others underwent an off-pump procedure. Eleven patients underwent CABG, mean number of anastomoses were 2.1 (range 1-4), two patients underwent aortic valve replacement. One patient underwent radical removal of pulmonary adenocarcinoma with local expansion into the left atrium. For the lung cancer lobectomy was necessary in 8, pneumectomy in 1, extirpation of multiple metastases in 1, resection of the trachea in 1 patient. Histological diagnosis was epidermoid carcinoma in 6, adenocarcinoma in 3, undifferentiated carcinoma in 1, metastasis of Grawitz tumor in 1, pneumoconiosis in 1 patient.


RESULTS
No patient died in hospital. One patient had to be re-explored for bleeding. Mean blood loss, duration of intubation and length of hospital stay were not different from other patients who underwent cardiac operation only.


CONCLUSIONS
In accordance with the majority of the data published in the literature, combined procedures did not negatively influence hospital morbidity and mortality. Simultaneous operations eliminate the necessity of a second operation and do not delay the postoperative oncological therapy. Long-term results are primarily determined by histological diagnosis and by the extent of the tumor.
Vojácek
J
J
Kardiochirurgische Klinik, Universitätsklinik Motol, 2. Medizinische Fakultät der Karls-Universität.
Hlubocký
J
J
Burkert
J
J
Brázdil
J
J
Durpekt
R
R
Valek
S
S
Spatenka
J
J
Lischke
R
R
Schützner
J
J
Smejkal
P
P
Horácek
M
M
Pafko
P
P
Pavel
P
P
D000368:Aged; D002283:Carcinoma, Bronchogenic / Q000150:complications / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006338:Heart Neoplasms / Q000150:complications / Q000473:pathology / Q000556:secondary / Q000601:surgery; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed