Short-Term Outcomes of Concomitant Robot-Assisted Coronary Artery Bypass Grafting and Minimally Invasive Lung Transplantation

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

Journal of Heart and Lung Transplantation

Abstract

Purpose: The optimal revascularization strategy for lung transplant candidates with significant coronary artery disease (CAD) is undefined. This study evaluates short-term outcomes of minimally invasive orthotopic lung transplantation (OLT) with concomitant robot-assisted coronary artery bypass grafting (CABG). Methods: This single-center, retrospective analysis compared 8 patients who underwent bilateral OLT with robot-assisted CABG to a control cohort of 164 consecutive uni-/bilateral OLT patients between 1/2021 and 6/2024 using clinical data retrieved from the institutional transplant database. Internal mammary artery harvest utilized the DaVinci Xi robot with robot ports inserted through an anterior mini-thoracotomy, chest tube site, and an additional port site, with a total of four arms used. Thereafter, beating-heart CABG and OLT was completed with our standard minimally invasive technique. Results: The CABG-OLT group was comparable to controls in age, sex, BMI, preoperative ejection fraction, and comorbidities, but had higher rates of CAD and CKD [Table 1]. All CABG-OLT patients received left internal mammary to left anterior descending artery grafts, with one requiring additional circumflex artery bypass. Only one patient required significant intra-operative blood products due to pleural adhesions. No patient required post-operative ECMO. Patients were extubated after 1 [1,3] days in the CABG-OLT cohort; one required tracheostomy. Table 1 compares intra- and post-operative characteristics between cohorts, with no increase in cardiovascular complications noted in the CABG-OLT group. No difference in primary graft dysfunction or postoperative graft function at one year was noted. All CABG-OLT patients are alive and doing well at median follow-up of 2.2 years. Conclusion: Concomitant robot-assisted CABG during minimally invasive OLT is feasible, allowing effective treatment of both end-stage lung disease and severe CAD with no added morbidity.

Volume

44

Issue

4 Suppl

First Page

S285

Comments

Richard DeVos Heart and Lung Transplant Program

45th Annual Meeting & Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT) Apr 27-30, 2025 Boston, MA

Last Page

S285

DOI

10.1016/j.healun.2025.02.595

ISSN

1053-2498

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