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COMBINED LUNG RESECTION AND AORTIC VALVE REPLACEMENT VIA MINISTERNOTOMY
COMBINED LUNG RESECTION AND
AORTIC VALVE REPLACEMENT VIA
MINISTERNOTOMY
Carlos-A Mestres, MD, PhD, José Belda, MD1,
Ernesto Greco, MD, Ramón Cartañá, MD,
José M Gimferrer, MD, PhD1
Department of Cardiovascular Surgery
1Department of Thoracic Surgery
Hospital Clinico
University of Barcelona
Barcelona, Spain
ABSTRACT
A technique for simultaneous cardiac operation and pulmonary resection via a
small upper midline sternotomy is described. It was employed in a 62-year-old man
undergoing aortic valve replacement and right lower lobectomy for a carcinoid
tumor.
(Asian Cardiovasc Thorac Ann 2001;9:155–6)
and a Heartport cannula (Heartport, Inc., Redwood City,
INTRODUCTION
CA, USA) in the right common femoral vein. A left
ventricular vent is inserted through the right superior
pulmonary vein. Cold blood cardioplegia is directly
infused into the coronary ostia. The aortic valve is resected
and annular debriding is carried out.A21-mm Carpentier-
Edwards pericardial xenograft (Edwards Lifesciences Inc.,
Irvine, CA, USA) is implanted using 2/0 braided everting
mattress sutures. Intracardiac air is carefully removed
and the aortotomy is closed. The incision is closed, leaving
2 chest tubes in place.
Minimally invasive cardiac surgery is becoming popular.
As well as a small anterior thoracotomy, parasternal,
upper transverse, and upper midline sternotomy incisions
have been tried. The rationale is to reduce surgical trauma,
wound complications, and hospital stay.1–3 Noncardiac
thoracic surgery has evolved in a similar way and video-
thoracoscopy has promoted less invasive surgical access,
even for radical treatment of cancer. Cardiac and pul-
monary diseases requiring surgical treatment can coexist,
and a simultaneous or sequential approach may be decided.
There are a few reports of simultaneous pulmonary
resection and cardiac surgery.4–7 Combined cardiac and
pulmonary operations are feasible and safe, and minimal
access might be considered in certain patients. The
DISCUSSION
The technique was employed in a 62-year-old man with
a history of smoking, hypertension, and duodenal ulcer,
following technique was devised to excise a right lower who presented with dyspnea and angina, and was found
lobe lung mass in a patient who also required aortic valve to be in New York Heart Association functional class II.
replacement.
Chest radiography showed a noncalcified right lower
lobe mass of 4 cm in diameter. Two-dimensional trans-
thoracic echocardiography confirmed calcified aortic
TECHNIQUE
A double-lumen endotracheal tube is placed. Through an stenosis with peak and mean gradients of 80/55 mm Hg,
upper midline “J” sternotomy, the lung mass is visualized and normal coronary arteries. Computed tomography
and a right lower lobectomy is performed using bronchial confirmed a solid noncalcified 42 × 35-mm right lower
stapling. Mediastinal nodes are dissected. Cardio- lobe mass (Figure 1). Biopsy disclosed a pulmonary
pulmonary bypass is established with aortic cannulation
carcinoid. Lung function was within normal limits. After
For reprint information contact:
Carlos-A Mestres, MD, PhD Tel: 34 93 227 5515 Fax: 34 93 451 4898 email: cmestres@mx3.redestb.es
Department of Cardiovascular Surgery, Hospital Clinico, University of Barcelona, Villarroel 170, Barcelona 08036, Spain.
2001, VOL. 9, N
O
. 2
155
ASIAN CARDIOVASCULAR & THORACIC ANNALS