Cardiac surgery in patients with previous carcinoma of the breast and mediastinal irradiation: Is the internal thoracic artery graft obsolete?

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.