CORONARY-ARTERY OPERATION IN PATIENTS AFTER BREAST-CANCER THERAPY

Objective. The purpose of this investigation was to retrospectively st udy the outcome of patients undergoing coronary artery operation who w ere previously treated for breast cancer. Methods. Between July 1992 a nd December 1996, 28 patients with a history of breast cancer underwen t coronary artery bypass graft operation and were randomly matched aga inst a noncancer group of similar size (n = 36) to allow for compariso n of their preoperative characteristics, operative course, and postope rative outcome. Results. The incidence of sternal wound infection was significantly higher in the cancer group than in the control group (25 % versus 6%; p = 0.027). Postoperative noncardiac chest pain occurred more frequently in the cancer group than in the control group (52% ver sus 31%; not significant). In the study group, radiotherapy and recent myocardial infarction were the only two independent factors associate d with sternal wound complications. Patients with a less than 17-year interval between the breast cancer therapy and the coronary artery ope ration had a higher incidence of sternal wound infection (46%) as oppo sed to patients with a longer time interval (7%; p = 0.028; odds ratio = 12). Sternal wound complications were more frequent in patients wit h a history of right-sided breast cancer (50%) compared with left-side d lesions (12.5%; p = 0.068; odds ratio = 7). Conclusions. Coronary ar tery operation in patients after breast cancer therapy may be associat ed with an increased sternal wound infection rate. To decrease this ri sk of infection, an approach through a right thoracotomy, minimally in vasive techniques, the use of skeletonized internal mammary artery, an d bread spectrum antibiotic therapy may be considered. (Ann Thorac Sur g 1998;66:1312-7) (C) 1998 by The Society of Thoracic Surgeons