Methods: Twenty-three patients (17 females, 6 males; mean age: 69.7±6.5 years; range, 59 to 83 years) who underwent concomitant off-pump coronary artery bypass grafting and thoracic surgery procedures for lung cancer or a thoracic mass between March 2018 and February 2024 were included in the retrospective study. The surgical approach was median sternotomy for off-pump coronary artery bypass grafting, and video-assisted thoracoscopic surgery was preferred for lung tumor resections. Mortality, major adverse cardiac events, cerebrovascular events, and duration of hospital stay were evaluated.

Results: There were no postoperative deaths or perioperative myocardial infarctions. None of the patients experienced pneumothorax or atelectasis. None of the patients sustained excessive blood loss requiring reoperation. Arterial grafts were the first choice during coronary artery bypass grafting. Wedge resections, lobectomies, segmentectomies were performed in the subsequent video-assisted thoracic surgery. All patients were followed for six to 86 months. Four patients died during the postoperative one-year period, and one patient died at postoperative 29 months due to cancer relapse. The overall one-year survival rate was 86.5%, and three- and five-year survival rates were 74% and 74%, respectively.

Conclusion: The video-assisted thoracoscopic surgery approach provides a more favorable perspective for pulmonary resection and mediastinal lymph node dissection, which has importance in patients" final diagnosis, than the sternal view due to more ample, wider workspace. Combined off-pump coronary artery bypass grafting and pulmonary resection in patients with lung cancer is safe and effective and reduces possible complications of a second major surgery.