Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
Division of Cardiovascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
J Surg Res. 2024 Oct;302:936-943. doi: 10.1016/j.jss.2024.07.082. Epub 2024 Sep 16.
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 (CLS). This study compares the survival outcomes of concomitant cardiac and lung surgeries during LTx.
A retrospective analysis of all single and double LTx patients from March 2012 to June 2023 at a single center was performed (n = 1099). Patients were stratified into three concomitant surgical groups: concomitant cardiac surgery (CCS), CLS, and no concomitant surgeries. Groups were compared on recipient demographics, diagnosis, and surgical intervention using analysis of variance and chi-square tests. Survival (5 y) was analyzed using Kaplan-Meier curves, log-rank test, and univariable Cox proportional hazard model where P value <0.05 was considered significant.
In total, 1099 patients were analyzed in this study; 965 had no concomitant surgery, 100 had CCS (mode: coronary artery bypass grafting, n = 75), and 34 had CLS (mode: lung volume reduction surgery, n = 14). Between the three surgical groups, there was no significant difference in body mass index (P = 0.091), total ischemic time (P = 0.194), induction (P = 0.140), or cause of death (P = 0.240). Lung allocation score and length of stay were significantly higher in the concomitant surgical groups, especially the CLS group when compared to the no concomitant surgery group (P = 0.002, P = 004). Patients with no concomitant surgery had a higher incidence of single LTx and off-pump utilization than concomitant surgical groups (P < 0.001). Kaplan-Meier curves and log-rank tests found no significant difference in survival between groups (P = 0.849). This result is supported by Cox proportional hazard model with no significant difference in mortality risk between the CCS group (P = 0.522) and CLS group (P = 0.936) compared to no concomitant surgery during LTx.
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.
关于肺移植（LTx）期间同时进行心脏和肺部手术的结果，数据有限。虽然有证据表明 LTx 期间的心脏手术对手术结果没有显著影响，但很少有数据研究同时进行肺部手术（CLS）的作用。本研究比较了 LTx 期间同时进行心脏和肺部手术的生存结果。
对 2012 年 3 月至 2023 年 6 月在单一中心接受单肺或双肺 LTx 的所有患者（n=1099）进行回顾性分析。患者分为三组：同时进行心脏手术（CCS）、CLS 和无同时手术。使用方差分析和卡方检验比较组间受体人口统计学、诊断和手术干预。使用 Kaplan-Meier 曲线、对数秩检验和单变量 Cox 比例风险模型分析生存（5 年），P 值<0.05 被认为具有统计学意义。
本研究共分析了 1099 例患者；965 例患者无同时手术，100 例患者行 CCS（模式：冠状动脉旁路移植术，n=75），34 例患者行 CLS（模式：肺减容术，n=14）。三组手术中，体重指数（P=0.091）、总缺血时间（P=0.194）、诱导（P=0.140）或死因（P=0.240）无显著差异。肺分配评分和住院时间在同时手术组显著升高，尤其是 CLS 组与无同时手术组相比（P=0.002，P=0.040）。无同时手术的患者比同时手术组更倾向于接受单肺 LTx 和非体外循环（P<0.001）。Kaplan-Meier 曲线和对数秩检验发现各组之间的生存无显著差异（P=0.849）。Cox 比例风险模型也没有发现 CCS 组（P=0.522）和 CLS 组（P=0.936）与 LTx 期间无同时手术相比，死亡率风险无显著差异，这一结果得到了支持。
本研究提供了有前景的数据，表明在 LTx 期间同时进行心脏或肺部手术的患者与仅接受 LTx 的患者的生存结果相似。这些结果强调了在需要进行复杂的胸部干预时，利用 LTx 来解决同时存在的胸部手术需求（如冠状动脉血运重建）的潜在优势。这对于优化患者护理和决策具有重要意义，特别是在需要进行复杂的胸部干预时。
