Reconstruction of the heart and the aorta for radical resection of lung cancer

Introduction: We report a single -center experience of resection and reconstruction of the heart and aorta infiltrated by lung cancer in order to prove that involvement of these structures is no longer a condition precluding surgery. Methods: Twenty-seven patients underwent surgery for lung cancer presenting full -thickness infiltration of the heart (n = 6) or the aorta (n = 18) and/or the supra -aortic branches (subclavian n = 3). Cardiac reconstruction was performed in 6 patients (5 atrium, 1 ventricle), with (n = 4) or without (n = 2) cardiopulmonary bypass, using a patch prosthesis (n = 4) or with deep clamping and direct suture (n = 2). Aortic or supra -aortic trunk reconstruction (n = 21) was performed using a heart -beating crossclamping technique in 14 cases (8 patch, 4 conduit, 2 direct suture), or without crossclamping by placing an endovascular prosthesis before resection in 7 (4 patch, 3 omental flap reconstruction). Neoadjuvant chemotherapy was administered in 13 patients, adjuvant therapy in 24. Results: All resections were complete (R0). Nodal staging of lung cancer was N0 in 14 cases, N1 in 10, N2 in 3. No intraoperative mortality occurred. Major complication rate was 14.8%. Thirty -day and 90 -day mortality rate was 3.7%. Median follow-up duration was 22 months. Recurrence rate is 35.4% (9/26: 3 loco -regional, 6 distant). Overall 3- and 5 -year survival is 60.9% and 40.6%, respectively. Conclusions: Cardiac and aortic resection and reconstruction for full -thickness infiltration by lung cancer can be performed safely with or without cardiopulmonary bypass and may allow long-term survival of adequately selected patients. (J Thorac Cardiovasc Surg 2024;167:1481-9)