Simultaneous aortic valve replacement and left lower lobectomy: technical considerations.

An 84-year-old patient underwent combined aortic valve replacement and left lower lobectomy (LLL) for bronchogenic cancer. At surgery, which was performed via median sternotomy, the fissure was found to be totally fused. The fissure, artery, and bronchus were treated off pump, while the left inferior pulmonary vein and the inferior ligament were sectioned on pump. Finally, the stenotic aortic valve was replaced with a bioprosthesis. The postoperative course was smooth and the patient discharged on the ninth day. The simultaneous treatment of lung cancer and cardiac disease has been widely described. LLL, on the other hand, represents a surgical challenge because the left ventricle obscures the pulmonary hilum. We have performed LLL combined to aortic valve replacement using a mixed approach, partly on pump and partly off pump to reduce bleeding and hemodynamic instability, which are well-known complications.