Pulmonary Resection Post-Coronary Artery Bypass Grafting: Feasible, but Right-Sided Procedures Demand Caution

This article examines the feasibility and technique of lung resection after prior coronary artery bypass grafting (CABG), focusing on resections ipsilateral to an internal thoracic artery graft. Among 5,821 pulmonary resections, 75 patients had previous CABG, and 38 underwent surgery on the same side as an internal thoracic artery (ITA) graft (24 LITA, 14 right internal thoracic arteries [RITA]). Adhesions between the lung and graft were common (68 percent), particularly on the right side, and were usually managed with careful adhesiolysis. In two cases, a thin parenchymal layer was deliberately left on the graft to avoid injury while completing lobectomy with negative margins. There were no intraoperative graft injuries or postoperative myocardial infarctions, but prolonged air leaks were more frequent in right-sided procedures. The 30-day mortality rate was zero percent, while the 90-day mortality rate was 5.4 percent. The authors conclude that ipsilateral pulmonary resection after CABG is feasible but technically demanding, with right sided cases related to the RITA requiring particular caution and graft preserving strategies.