Objective: To explore perioperative management of the high risk patients undergoing major pulmonary resection with concommittent cardiac disease. Methods:Between January 1991 and August 2001 the case notes of all patients having undergone pulmonary resection for primary lung cancer under the care of a single Consultant Thoracic Surgeon at the Royal Brompton Hospital were reviewed retrospectively ( n =348). Two groups were identified: those with known pre-existing cardiac disease (Group A) and those without (Group B). Morbidity and mortality were compared between the two groups. Results: The morbidity and mortality in Group A were 22.1% and 3.5% respectively

in Group B 12.4% and 1.9% respectively

with overall figures of 17.8% and 2.3% respectively. Cardiac complications accounted for the major cause of morbidity and mortality following lung resection

and no significant difference was found between the two groups ( P >0.05). Conclusion: Elderly patients with stable or surgically treated cardiac disease should not be denied pulmonary resection for primary lung cancer. Cardiological assessment should be sought for all patients with known or suspected cardiac disease prior to pulmonary surgery. In our experience we advocate myocardial revascularisation prior to lung resection in patients with severe left main stem or triple-vessel coronary artery disease along with careful re-evaluation of those patients who underwent coronary artery surgery greater than 5 years previously.