M. Azuma1, M. A. Kashem1, R. Yanagida1, N. Shigemura1, Y. Toyoda1 1Lewis Katz School of Medicine, Cardiovascular Sugery, Philadelphia, PA, USA
Introduction: There is limited data concerning concomitant cardiac and lung surgery outcomes during lung transplantation (LTx). While some evidence suggests that cardiac surgery during LTx has no significant impact on surgical outcomes, scarce data examines the role of concomitant lung surgery. This study compares the survival outcomes of concomitant cardiac and lung surgeries during LTx.
Methods: A retrospective analysis of all single and double LTx patients from February 2012 to June 2023 at a single center was performed (n=1110). Patients were stratified into three concomitant surgical groups: concomitant cardiac surgery (CCS), concomitant lung surgery (CLS), and no concomitant surgeries. Groups were compared on recipient demographics, diagnosis, and surgical intervention using ANOVA and chi-square tests. Survival (10 years) was analyzed using Kaplan-Meier (KM) curves, log-rank test, and univariable Cox proportional hazard model where p-value <0.05 was considered significant. All statistical analysis was done on JMP pro, version 17.
Results: In total, 1110 patients were analyzed in this study; 964 had no concomitant surgery, 111 had CCS (mode: CABG, n=75), and 35 had CLS (mode: LVRS, n=22). The patients were majority Caucasian males across all three groups (p<0.001). Between the three surgical groups, there was no significant difference in BMI (p=0.257), total ischemic time (p=0.149), induction (p=0.237), or cause of death (p=0.309). Lung allocation score (LAS) and length of stay (LOS) were significantly higher in the concomitant surgical groups, especially the CLS group, when compared to the no concomitant surgery group (p<0.001). Patients with no concomitant surgery had a higher incidence of single LTx and off-pump utilization than concomitant surgical groups (p<0.001). KM curves and log-rank tests found no significant difference in survival between groups (p=0.950). This result is supported by Cox proportional hazard model with no significant difference in mortality risk between the CCS group (p=0.830) and CLS group (p=0.802) compared to the no concomitant surgery group during LTx.
Conclusion: Our study provides promising data indicating that individuals undergoing concomitant heart or lung surgery during LTx have similar survival outcomes to those exclusively undergoing LTx. These results highlight the potential advantages of utilizing LTx to address concurrent thoracic surgical needs, such as coronary revascularization. This holds implications for optimizing patient care and decision-making when complex thoracic interventions are necessary.
