Coronary Artery Bypass Grafting after Pneumonectomy

When open-heart operations are necessary in patients who have undergone pneumonectomy, the unavoidable shift of mediastinal structures should be carefully considered. Surgical access, revascularization procedures, and the institution of cardiopulmonary bypass can all require approaches that differ from the usual. In particular, no general recommendations exist regarding the management of patients who undergo coronary artery bypass grafting after pneumonectomy.We successfully performed coronary artery bypass grafting in a 57-year-old man who had undergone a left pneumonectomy 7 years previously. Because the patient''s heart was completely displaced into the left posterior hemithorax, access via a left posterolateral thoracotomy was chosen. Saphenous vein grafts were chosen over the internal mammary artery. The distal anastomoses were performed with use of the off-pump technique; for the proximal anastomosis, 2 venous grafts were implanted into the descending aorta. The patient''s postoperative course was uneventful, and postoperative angiography revealed patent grafts. Herein, we discuss the case of this patient, and we present some considerations that can influence surgical approaches in similar circumstances.Key words: Angina, unstable/surgery; cardiopulmonary bypass; coronary artery bypass/methods; coronary disease/surgery; pneumonectomy; respiratory insufficiencyA 57-year-old man, who had undergone left pneumonectomy 7 years earlier, presented with symptoms of unstable angina. Examination revealed triple-vessel disease, respiratory dysfunction, and complete displacement of the heart and the great vessels to the posterior wall of the left pleural cavity. Here, we discuss the case of this patient and the management of coronary artery bypass grafting (CABG) when the heart is completely displaced after pneumonectomy.