We investigated the perioperative management and prognosis of coexisting ischemic heart disease (IHD) in patients undergoing surgery for lung cancer. Of the 809 patients with primary lung cancer referred for surgery between July 1987 and December 1999, 236 were suspected of having IHD before surgery and underwent cardiac catheterization. Sixty-nine of these patients were found to have significant coronary stenosis (>75%) on coronary angiography. A unilateral pulmonary occlusion test was performed in 40 patients, and the total pulmonary vascular resistance index was over 800 in 8 patients. Surgery was judged to be contraindicated in three patients. Twelve patients underwent percutaneous transluminal coronary angioplasty before surgery. The surgical procedures were combined with drug therapy (n=38), simultaneous coronary artery bypass graft (n=10), and assisted circulation with an intra-aortic balloon pump (n=4). Although myocardial infarction occurred during surgery in two patients, they improved and were discharged from hospital. Severe respiratory complications were the major problems that required management after surgery. Our selection of surgical indications in lung cancer patients based on preoperative evaluation of cardiopulmonary function, appropriate surgical procedures, and perioperative revascularization resulted in no perioperative cardiac death. The perioperative revascularization group of stage I patients with IHD had a longer survival time than the non-revascularization group
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