Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS31. Ten-Year Experience of Off-Pump Coronary Artery Bypass; LessonsLearned from Early Postoperative AngiogramsKi-Bong Kim, Jun-Sung Kim, Hae-Young Lee, Hyun-Jae Kang, Bon-Kwon Koo,Hyo-Soo Kim, Dae-Won Sohn, Byung-Hee Oh, Young-Bae ParkSeoul National University Hospital, Seoul, South KoreaInvited Discussant: Joseph F. Sabik, IIIOBJECTIVE: We have performed early postoperative angiograms to assess theaccuracy and patency of the anastomosis after off-pump coronary artery bypass(OPCAB).METHODS: One thousand and three hundred forty five patients who underwentOPCAB between January 1998 and December 2007 were studied. The grafts usedfor distal anastomoses were left internal thoracic artery (n = 1278), right internalthoracic artery (n = 677), right gastroepiploic artery (n = 837), radial artery (n = 14),and saphenous vein (n = 190). Early postoperative (1.8 ± 1.7 days) angiographieswere performed in 1306 patients (97.1%). The patients were divided into group I(n = 234), which underwent OPCAB without using intraoperative graft flowmeasurement, and group II (n = 1111), which under went OPCAB with flowmeasurement.RESULTS: Operative mortality was 1.6%. The average number of distal anastomoseswas 3.0 ± 1.0. Early postoperative patency rates were 98.8% (3554/3597) for arterialgrafts and 88.2% (285/323) for vein graft (p = 0.00). In group II, intraoperativeflowmeter-guided graft revision was performed in 2.6% (84/3239) of anastomoses.Patency rate of arterial grafts was significantly higher in group II than in group I(97.2%, 455/468 vs 99.0%, 3099/3129; p = 0.001); however, patency rates of veingraft was not different between the two groups (86.4%, 184/213 vs 91.8%, 101/110;p = ns). Early postoperative reoperation for graft revision was performed in 33patients (6.4%, 15/234 in group I vs 1.6%, 18/1111 in group II; p = 0.001) based onthe angiographic finding.CONCLUSION: The early postoperative patency rate of vein graft after OPCABwas significantly lower than that of arterial grafts. Intraoperative flow measurementsignificantly improved the patency rate of arterial grafts and decreased thereoperation rate for graft revision. There were 1.6% of patients requiring reoperationbased on the early angiographic findings in spite of the intraoperative flowmeterguidedrevision.156
AMERICAN ASSOCIATION FOR THORACIC SURGERY32. Pneumonectomy After Chemo- or Chemoradiotherapy for AdvancedNon-Small Cell Lung CancerWalter Weder, 1* Stéphane Collaud, 1 Thomas Krbek, 2 Sven Hillinger, 1 Sylvia Fechner, 2Peter Kestenholz, 1 Rolf Stahel, 1 Georgios Stamatis 21. Zurich University Hospital, Zürich, Switzerland; 2. Ruhrlandklinik, Essen, GermanyInvited Discussant: Robert J. CerfolioOBJECTIVE: Pneumonectomy after chemo- or chemoradiotherapy is reported tobe associated with a mortality of up to 20%. We retrospectively reviewed medicalrecords of patients who underwent standard or extended pneumonectomy afterinduction therapy for advanced NSCLC.METHODS: 827 patients underwent induction therapy for NSCLC after stagingwith CT, PET-CT and/or mediastinoscopy in two different centers from 1998–2007.Induction chemotherapy consisted mainly of 3 cycles of a platin-based regimen.Chemoradiotherapy consisted of an additional radiation of 45 Gy. Re-staging wasperformed with CT, PET-CT and/or re-mediastinoscopy prior to surgical resection.Patients who underwent a pneumonectomy were further analyzed.RESULTS: 176 pneumonectomies were performed. 117 (66%) were extendedresections including pericardium in 108 (60%), left atrium in 31 (18%), diaphragmin 10 (6%), chest wall in 8 (5%), superior vena cava in 7 (4%), aorta in 7 (4%) andoesophageal muscle in 5 (3%) patients. R0-resection was achieved in 165 (94%).TUESDAYMorningPre-induction clinical stage was IIB in 8 (5%), IIIA in 96 (54%), IIIB in 71 (40%)and IV in 1 (1%) patient. Post-induction pathological stage was a complete responsein 36 (20%), stage I in 31 (18%), II in 39 (22%), III in 58 (33%) and IV in 12 (7%).There were 6 perioperative deaths (3% mortality) due to pulmonary embolism in3, respiratory failure (pneumonia/ARDS) in 2 and cardiac failure in 1 patient.Within 90 post-operative days, 22 major complications occurred in 19 patients(11%): 6 (27%) broncho-pleural fistulas (BPF), 6 (27%) pneumonias/ARDS, 5(23%) empyemas without BPF, 4 (18%) pulmonary embolism and 1 (5%) gastricherniation due to displacement of the diaphragmatic repair.3- and 5-year survivals for the overall population were 55% and 38%, respectively.CONCLUSION: Pneumonectomy after chemo- or chemoradiotherapy as inductionfor advanced NSCLC can be performed with a perioperative mortality rate of 3%and should not exclude patients from surgical resection. The achieved 5-year survivalrate of 38% justifies aggressive surgery within a multimodality concept forselected cases.10:05 a.m. INTERMISSION – VISIT EXHIBITSExhibit Hall* AATS Member157
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AATS FUTURE MEETINGSMay 1-5, 2010Me
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