B. Gansera et al., Cardiac surgery in patients with previous carcinoma of the breast and mediastinal irradiation: Is the internal thoracic artery graft obsolete?, THOR CARD S, 47(6), 1999, pp. 376-380
Background: The increasing number of patients of more advanced age undergoi
ng cardiac surgery means the number of those with previous curative (relaps
e free) mastectomy and irradiation of the chest is also increasing. A highe
r incidence of postoperative complications such as sternal infection in the
se patients is considered possible. Furthermore the question of whether med
iastinal irradiation leads to a relevant internal thoracic artery (ITA) gra
ft damage remains unclear. In this context the benefit of arterial revascul
arization (CABG) using one or both ITAs is not sufficiently proven by data
available from clinical studies. Method: 70 patients (49-85 years) with pre
vious mastectomy or Hodgkin/non-Hodgkin's disease and mediastinal irradiati
on underwent CABG (n=59) or an aortic valve replacement (AVR, n=11). 20 pat
ients received bilateral internal thoracic artery grafts, 34 a single inter
nal thoracic artery graft, and in 16 patients an internal thoracic artery w
as not used. Perioperative data and data concerning postoperative complicat
ions such as mortality, myocardial infarction, and sternal infection or ref
ixation was gathered and compared with all other patients receiving CABG (n
= 5102). An histological investigation of ITA segments was done in 12 pati
ents. Results: There was no significant enhancement of the perioperative ri
sk in comparison with other patients of a corresponding age group. Internal
thoracic artery damage induced by irradiation was not present. There was n
o increased incidence of sternal instability requiring refixation observed.
Conclusion: In the patient cohort investigated there is in general no need
for restrictive use of the ITA in CABG.