Quality of Internal Thoracic Artery Grafts After Mediastinal Irradiation

Gansera, Brigitte; Schmidtler, F.; Angelis, I; Botzenhardt, Florian; Schuster, Tibor; Kiask, T; Haschemi, Ayman; Kemkes, B. M.

doi:10.1016/j.athoracsur.2007.06.034

Cited by 31 publications

(20 citation statements)

References 24 publications

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“…However, a previous study has suggested that IMAs should be used in patients with prior chest irradiation. 27 As described above, the indications and contraindications of BIMA use are controversial. We included in the regression models variables that are reasonably involved in the decision-making process of choosing the IMA for a CABG; however, we did not include possible confounders such as a patient's socioeconomic status and insurance status.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Variability of Internal Mammary Artery Graft Use in Contemporary Multivessel Coronary Artery Bypass Graft Surgery

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Prevalence and Variability of Internal Mammary Artery Graft Use in Contemporary Multivessel Coronary Artery Bypass Graft Surgery

et al. 2009

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“…Prior chest irradiation might also make a surgeon hesitant to use IMA. However, a previous study has suggested that IMAs should be used in patients with prior chest irradiation [26]. Thus, given that there are relatively few contraindications to the use of the IMA, one would anticipate a uniformly high use of this unequivocally valuable conduit.…”

Section: Discussionmentioning

confidence: 95%

Prevalence and variability of internal mammary graft use in contemporary multivessel coronary artery bypass graft

Schmitto

Rajab

Cohn

2010

Current Opinion in Cardiology

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There is strong evidence that IMA graft use is associated with significantly improved short-term and long-term survival in CABG. In spite of this, the prevalence of IMA grafting is less than expected. Moreover, there is a large variability in IMA use by hospital. There are also disparities in IMA use by sex and race, which should be addressed in the interest of expanding the benefits of IMA grafting to the maximum possible number of patients. Although the frequency of IMA use in CABG procedures seems to increase each year, further actions are necessary at the individual clinician, institutional, and political levels to improve quality of care.

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“…The left internal mammary artery (LIMA) is typically used as a bypass conduit. Despite concerns that radiation might damage the LIMA, increase its fragility, and lead to early graft failure [18, 19], recent studies have documented patency rates comparable to that of venous grafts at 5 year follow-up [20, 21], making LIMA grafting a viable option for RICAD as well. Yet cardiac surgery in patients with past chest irradiation can still be technically challenging, with a greater risk of perioperative complications in the presence of pericardial thickening and retrosternal fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Isolated Left Main Coronary Artery Stenosis after Thoracic Radiation Therapy: To Operate or Not to Operate

Alsara

Alsarah

Kalavakunta

et al. 2013

Case Reports in Medicine

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Radiation therapy of neoplasms involving the chest or mediastinum results in a wide spectrum of cardiac complications including coronary artery disease, which can present in patients with few or no traditional cardiac risk factors. We report a case of radiation induced coronary artery disease in a 60-year-old female with a history of stage IIIA nonsmall cell lung carcinoma which was diagnosed eight years earlier and treated with chemotherapy and radiotherapy. She presented to the hospital with atypical chest pain that had occurred intermittently over the preceding week. Her initial electrocardiogram and cardiac enzymes were within normal limits. However, following an indeterminate exercise nuclear stress test, she developed chest pain and elevated cardiac enzymes. Coronary angiography demonstrated 90% stenosis of the left main coronary artery ostium, without any evidence of atherosclerotic disease or stenosis in other coronary arteries. She underwent surgical revascularization, which revealed dense adhesions surrounding the heart. During surgery, she developed severe bleeding and died. Coronary artery disease can present within years of radiation exposure, and ostial lesions are typical. Treatment is often challenging because of the effects of radiation on other tissues and the risks of revascularization procedures. Therefore, a multidisciplinary team approach should be considered.

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Quality of Internal Thoracic Artery Grafts After Mediastinal Irradiation

Cited by 31 publications

References 24 publications

Prevalence and Variability of Internal Mammary Artery Graft Use in Contemporary Multivessel Coronary Artery Bypass Graft Surgery

Prevalence and Variability of Internal Mammary Artery Graft Use in Contemporary Multivessel Coronary Artery Bypass Graft Surgery

Prevalence and variability of internal mammary graft use in contemporary multivessel coronary artery bypass graft

Isolated Left Main Coronary Artery Stenosis after Thoracic Radiation Therapy: To Operate or Not to Operate

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