Coronary artery bypass grafting in patients with previous mediastinal radiation therapy

Objectives: Our objectives were to characterize the outcome of coronary art ery bypass grafting in patients with previous mediastinal radiation therapy and to identify special features of this condition that relate to surgical management. Patients ann methods: We conducted a retrospective review of 4 7 patients (28 women, 19 men) with a mean age of 63.5 +/- 12.8 years (range 31.0-82.9 years) from 1976 through December 1996 undergoing coronary arter y bypass graft after mediastinal radiation therapy. Results: The mean inter val between mediastinal radiation therapy and coronary artery bypass grafti ng was 15.1 +/- 9.8 years (range 1.1-37.8 years), In the 44 patients with i solated coronary surgery, operative mortality was 3 patients (6.8%), Sterna l wound infection occurred in 3 patients (6.8%), Actuarial survival at 1 an d 5 years was 87.2% +/- 4.9% and 71.6% +/- 7.1%, respectively. Total follow -up was 293.7 patient-years (mean 6.2 +/- 5.1 years). There were 17 late de aths (malignancy, n = 7; heart failure, n = 6; stroke, n = 1; other noncard iac causes, n = 2; and sudden death, n = 1), Twelve of 43 discharged patien ts had the development of valvular disease demonstrated by follow-up echoca rdiography. Conclusions: The early results of coronary artery bypass grafti ng for the treatment of ischemic heart disease after mediastinal radiation therapy are good. Late survival, however, is limited by malignancy, either recurrent or new, and the development of heart failure. Inasmuch as 25 othe r patients after radiation therapy required concomitant valve surgery and 1 2 of 43 (28%) discharged patients had later development of valvular disease , with 2 requiring reoperation, careful assessment of any valvular lesion i s important during the initial coronary artery bypass grafting. Careful fol low-up, including regular echocardiographic screening, is recommended in th is patient population.