title: Left upper lobectomy after coronary artery bypass grafting.
abstract: OBJECTIVE
  Left upper pulmonary lobectomy or segmentectomy after coronary artery bypass grafting (CABG) risks injury to the grafts. We reviewed our experience.
  
  
  METHODS
  This is a retrospective review of a prospective database from 1 surgeon, of patients who underwent left upper lobectomy after having previous CABG.
  
  
  RESULTS
  Between June 1998 and June 2014, a total of 2207 patients underwent lobectomy by 1 surgeon; 458 (21%) had a left upper lobectomy, and 28 (6.1%) had had a previous CABG. Twenty-seven patients (96.4%) had a left internal mammary artery (LIMA) used for the bypass. Twenty-six patients (96.2%) had significant adhesions between their lung and the bypass grafts. Of patients who had a LIMA graft, 25 (92.6%) had the left upper lobe completely dissected free from their grafts, whereas 2 patients (7.1%) had a sliver of their lung left on the grafts. No patient had a postoperative myocardial infarction, and 30-day and 90-day survival rates were both 100%. All patients had a curative resection, and all had complete thoracic lymphadenectomy.
  
  
  CONCLUSIONS
  Left upper lobectomy after CABG, in patients with previous CABG and LIMA grafting, is safe. Usually the entire lung can be safely mobilized off the bypass grafts; if needed, a small sliver of lung can be left on the grafts. A curative resection is possible with minimal perioperative cardiac morbidity, and excellent 30- and 90-day mortality.
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham Medical Center, Birmingham, Ala.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wei
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham Medical Center, Birmingham, Ala.
authors.forename: Brett
authors.initials: B
authors.lastname: Broussard
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham Medical Center, Birmingham, Ala.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Bryant
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham Medical Center, Birmingham, Ala.
authors.forename: Paul
authors.initials: P
authors.lastname: Linsky
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham Medical Center, Birmingham, Ala.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Minnich
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham Medical Center, Birmingham, Ala. Electronic address: rcerfolio@uabmc.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cerfolio
mesh_terms: D000368:Aged; D000407:Alabama; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D000267:Tissue Adhesions; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Coronary artery bypass grafting; internal mammary artery; left upper lobectomy