Pulmonary resection post–coronary artery bypass grafting: Feasible, but right-sided procedures demand caution

Objective: The study objective was to evaluate the feasibility and technical considerations of pulmonary resection after coronary artery bypass grafting, with emphasis on procedures ipsilateral to an internal thoracic artery graft and the role of preoperative 3-dimensional imaging. Methods: We retrospectively reviewed 75 patients who underwent pulmonary resection after coronary artery bypass grafting between January 2008 and April 2024. Thirty-eight patients underwent pulmonary resection on the same side as internal thoracic artery grafting. Preoperative 3-dimensional reconstructed coronary or contrast-enhanced computed tomography was used to delineate graft anatomy in 23 patients. Results: = .043). The 30-day mortality rate was 0%, and the 90-day mortality rate was 5.4%. Conclusions: Pulmonary resection after coronary artery bypass grafting is feasible but technically demanding and requires meticulous preoperative planning and careful intraoperative judgment, particularly during adhesiolysis near patent grafts. Preoperative 3-dimensional imaging provides supportive anatomical guidance for graft localization but should be regarded as adjunctive rather than outcome proven. In cases of dense adhesions, avoiding forceful adhesiolysis and selectively preserving a thin parenchymal layer adjacent to the graft, while otherwise completing the planned lobectomy, may represent a pragmatic graft-preserving strategy that maintains oncologic adequacy when negative margins are achieved.