Quality of Internal Thoracic Artery Grafts After Mediastinal Irradiation
Background With the increase of patients of advanced age requiring coronary artery bypass grafting (CABG), the number of those with previous mastectomy and irradiation of the chest increases proportionally. The question of whether mediastinal irradiation leads to relevant internal thoracic artery (I...
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Veröffentlicht in: | The Annals of thoracic surgery 2007-11, Vol.84 (5), p.1479-1484 |
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creator | Gansera, Brigitte, MD Schmidtler, Fabian, MD Angelis, Ilias, MD Botzenhardt, Florian, MD Schuster, Tibor, MD Kiask, Theodor, MD Haschemi, Ayman, MD Kemkes, Bernhard M., MD, PhD |
description | Background With the increase of patients of advanced age requiring coronary artery bypass grafting (CABG), the number of those with previous mastectomy and irradiation of the chest increases proportionally. The question of whether mediastinal irradiation leads to relevant internal thoracic artery (ITA) graft damage remains unclear. The aim of the present study was to proof the quality of ITAs and to evaluate the early clinical outcome after using one or both ITAs in this specific population. Methods One hundred twenty-five patients (group A) with previous mastectomy or Hodgkin/non-Hodgkin disease and mediastinal irradiation operated on between January 1993 and September 2006 underwent CABG (n = 88) or CABG plus valve replacement (n = 37). Sixty-two patients received bilateral, 43 received unilateral ITAs, and 20 patients received veins. Postoperative complications and mortality were analyzed and compared with a propensity score pair-matched control group of 125 patients receiving CABG or CABG plus valve replacement within the same period (group B). A histomorphologic investigation was performed in 133 irradiated distal ITA segments and compared with a control group of 133 nonirradiated ITAs. Results Thirty-day mortality revealed 3.2% in group A versus 5.6% in group B. Sternal instabilities were more frequent in group A (3.2%) than in group B (0%). Mediastinitis occurred in 1.6% (group A) versus 1.6% (group B). Histomorphologic investigations did not identify any severe irradiation induced fibrosis or damage of ITA grafts. Conclusions From the histologic point of view, there is no need for restrictions in use of ITA conduits after mediastinal irradiation. Compared with a control group, cardiac surgery was associated with a slightly enhanced incidence of sternal instabilities. |
doi_str_mv | 10.1016/j.athoracsur.2007.06.034 |
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The question of whether mediastinal irradiation leads to relevant internal thoracic artery (ITA) graft damage remains unclear. The aim of the present study was to proof the quality of ITAs and to evaluate the early clinical outcome after using one or both ITAs in this specific population. Methods One hundred twenty-five patients (group A) with previous mastectomy or Hodgkin/non-Hodgkin disease and mediastinal irradiation operated on between January 1993 and September 2006 underwent CABG (n = 88) or CABG plus valve replacement (n = 37). Sixty-two patients received bilateral, 43 received unilateral ITAs, and 20 patients received veins. Postoperative complications and mortality were analyzed and compared with a propensity score pair-matched control group of 125 patients receiving CABG or CABG plus valve replacement within the same period (group B). A histomorphologic investigation was performed in 133 irradiated distal ITA segments and compared with a control group of 133 nonirradiated ITAs. Results Thirty-day mortality revealed 3.2% in group A versus 5.6% in group B. Sternal instabilities were more frequent in group A (3.2%) than in group B (0%). Mediastinitis occurred in 1.6% (group A) versus 1.6% (group B). Histomorphologic investigations did not identify any severe irradiation induced fibrosis or damage of ITA grafts. Conclusions From the histologic point of view, there is no need for restrictions in use of ITA conduits after mediastinal irradiation. Compared with a control group, cardiac surgery was associated with a slightly enhanced incidence of sternal instabilities.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2007.06.034</identifier><identifier>PMID: 17954049</identifier><identifier>CODEN: ATHSAK</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Biological and medical sciences ; Cardiothoracic Surgery ; Coronary Artery Bypass - adverse effects ; Coronary Artery Bypass - methods ; Female ; Humans ; Male ; Mammary Arteries - pathology ; Mammary Arteries - transplantation ; Mediastinum - radiation effects ; Mediastinum - surgery ; Medical sciences ; Middle Aged ; Postoperative Complications - etiology ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Surgery of the respiratory system</subject><ispartof>The Annals of thoracic surgery, 2007-11, Vol.84 (5), p.1479-1484</ispartof><rights>The Society of Thoracic Surgeons</rights><rights>2007 The Society of Thoracic Surgeons</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c559t-90d0e1befb146e02e8521b9bad9d37f076eed9bb07e0ae9143e41c82a97c2ab53</citedby><cites>FETCH-LOGICAL-c559t-90d0e1befb146e02e8521b9bad9d37f076eed9bb07e0ae9143e41c82a97c2ab53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19215603$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17954049$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gansera, Brigitte, MD</creatorcontrib><creatorcontrib>Schmidtler, Fabian, MD</creatorcontrib><creatorcontrib>Angelis, Ilias, MD</creatorcontrib><creatorcontrib>Botzenhardt, Florian, MD</creatorcontrib><creatorcontrib>Schuster, Tibor, MD</creatorcontrib><creatorcontrib>Kiask, Theodor, MD</creatorcontrib><creatorcontrib>Haschemi, Ayman, MD</creatorcontrib><creatorcontrib>Kemkes, Bernhard M., MD, PhD</creatorcontrib><title>Quality of Internal Thoracic Artery Grafts After Mediastinal Irradiation</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Background With the increase of patients of advanced age requiring coronary artery bypass grafting (CABG), the number of those with previous mastectomy and irradiation of the chest increases proportionally. The question of whether mediastinal irradiation leads to relevant internal thoracic artery (ITA) graft damage remains unclear. The aim of the present study was to proof the quality of ITAs and to evaluate the early clinical outcome after using one or both ITAs in this specific population. Methods One hundred twenty-five patients (group A) with previous mastectomy or Hodgkin/non-Hodgkin disease and mediastinal irradiation operated on between January 1993 and September 2006 underwent CABG (n = 88) or CABG plus valve replacement (n = 37). Sixty-two patients received bilateral, 43 received unilateral ITAs, and 20 patients received veins. Postoperative complications and mortality were analyzed and compared with a propensity score pair-matched control group of 125 patients receiving CABG or CABG plus valve replacement within the same period (group B). A histomorphologic investigation was performed in 133 irradiated distal ITA segments and compared with a control group of 133 nonirradiated ITAs. Results Thirty-day mortality revealed 3.2% in group A versus 5.6% in group B. Sternal instabilities were more frequent in group A (3.2%) than in group B (0%). Mediastinitis occurred in 1.6% (group A) versus 1.6% (group B). Histomorphologic investigations did not identify any severe irradiation induced fibrosis or damage of ITA grafts. Conclusions From the histologic point of view, there is no need for restrictions in use of ITA conduits after mediastinal irradiation. Compared with a control group, cardiac surgery was associated with a slightly enhanced incidence of sternal instabilities.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiothoracic Surgery</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Coronary Artery Bypass - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Mammary Arteries - pathology</subject><subject>Mammary Arteries - transplantation</subject><subject>Mediastinum - radiation effects</subject><subject>Mediastinum - surgery</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Complications - etiology</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Surgery of the respiratory system</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU1r3DAQhkVoaDZp_0LwJb3ZGX1Zq0tgG9pkIaGEpGchy2OqrddOJbmw_75yd2Ehp5zEKz0zI54hpKBQUaD19aay6dcYrItTqBiAqqCugIsTsqBSsrJmUn8gCwDgpdBKnpHzGDc5svz8kZxRpaUAoRfk_mmyvU-7YuyK9ZAwDLYvXv739q5YhXyzK-6C7VIsVl1OxSO23sbkZ3Adgs0p-XH4RE4720f8fDgvyM_v315u78uHH3fr29VD6aTUqdTQAtIGu4aKGoHhUjLa6Ma2uuWqA1UjtrppQCFY1FRwFNQtmdXKMdtIfkG-7Pu-hvHPhDGZrY8O-94OOE7R1EvBOFOQweUedGGMMWBnXoPf2rAzFMxs0WzM0aKZLRqoTbaYSy8PM6Zmi-2x8KAtA1cHwEZn-y7Ywfl45HT2XAPP3Nc9h9nIX4_BROdxcFlhQJdMO_r3_ObmTRPX-8Hnub9xh3EzTvPSoqEmMgPmed76vHRQQLkAzf8BzaOq_w</recordid><startdate>20071101</startdate><enddate>20071101</enddate><creator>Gansera, Brigitte, MD</creator><creator>Schmidtler, Fabian, MD</creator><creator>Angelis, Ilias, MD</creator><creator>Botzenhardt, Florian, MD</creator><creator>Schuster, Tibor, MD</creator><creator>Kiask, Theodor, MD</creator><creator>Haschemi, Ayman, MD</creator><creator>Kemkes, Bernhard M., MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20071101</creationdate><title>Quality of Internal Thoracic Artery Grafts After Mediastinal Irradiation</title><author>Gansera, Brigitte, MD ; Schmidtler, Fabian, MD ; Angelis, Ilias, MD ; Botzenhardt, Florian, MD ; Schuster, Tibor, MD ; Kiask, Theodor, MD ; Haschemi, Ayman, MD ; Kemkes, Bernhard M., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c559t-90d0e1befb146e02e8521b9bad9d37f076eed9bb07e0ae9143e41c82a97c2ab53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiothoracic Surgery</topic><topic>Coronary Artery Bypass - adverse effects</topic><topic>Coronary Artery Bypass - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Mammary Arteries - pathology</topic><topic>Mammary Arteries - transplantation</topic><topic>Mediastinum - radiation effects</topic><topic>Mediastinum - surgery</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Complications - etiology</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Surgery of the respiratory system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gansera, Brigitte, MD</creatorcontrib><creatorcontrib>Schmidtler, Fabian, MD</creatorcontrib><creatorcontrib>Angelis, Ilias, MD</creatorcontrib><creatorcontrib>Botzenhardt, Florian, MD</creatorcontrib><creatorcontrib>Schuster, Tibor, MD</creatorcontrib><creatorcontrib>Kiask, Theodor, MD</creatorcontrib><creatorcontrib>Haschemi, Ayman, MD</creatorcontrib><creatorcontrib>Kemkes, Bernhard M., MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gansera, Brigitte, MD</au><au>Schmidtler, Fabian, MD</au><au>Angelis, Ilias, MD</au><au>Botzenhardt, Florian, MD</au><au>Schuster, Tibor, MD</au><au>Kiask, Theodor, MD</au><au>Haschemi, Ayman, MD</au><au>Kemkes, Bernhard M., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quality of Internal Thoracic Artery Grafts After Mediastinal Irradiation</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2007-11-01</date><risdate>2007</risdate><volume>84</volume><issue>5</issue><spage>1479</spage><epage>1484</epage><pages>1479-1484</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><coden>ATHSAK</coden><abstract>Background With the increase of patients of advanced age requiring coronary artery bypass grafting (CABG), the number of those with previous mastectomy and irradiation of the chest increases proportionally. The question of whether mediastinal irradiation leads to relevant internal thoracic artery (ITA) graft damage remains unclear. The aim of the present study was to proof the quality of ITAs and to evaluate the early clinical outcome after using one or both ITAs in this specific population. Methods One hundred twenty-five patients (group A) with previous mastectomy or Hodgkin/non-Hodgkin disease and mediastinal irradiation operated on between January 1993 and September 2006 underwent CABG (n = 88) or CABG plus valve replacement (n = 37). Sixty-two patients received bilateral, 43 received unilateral ITAs, and 20 patients received veins. Postoperative complications and mortality were analyzed and compared with a propensity score pair-matched control group of 125 patients receiving CABG or CABG plus valve replacement within the same period (group B). A histomorphologic investigation was performed in 133 irradiated distal ITA segments and compared with a control group of 133 nonirradiated ITAs. Results Thirty-day mortality revealed 3.2% in group A versus 5.6% in group B. Sternal instabilities were more frequent in group A (3.2%) than in group B (0%). Mediastinitis occurred in 1.6% (group A) versus 1.6% (group B). Histomorphologic investigations did not identify any severe irradiation induced fibrosis or damage of ITA grafts. Conclusions From the histologic point of view, there is no need for restrictions in use of ITA conduits after mediastinal irradiation. Compared with a control group, cardiac surgery was associated with a slightly enhanced incidence of sternal instabilities.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>17954049</pmid><doi>10.1016/j.athoracsur.2007.06.034</doi><tpages>6</tpages></addata></record> |
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subjects | Aged Biological and medical sciences Cardiothoracic Surgery Coronary Artery Bypass - adverse effects Coronary Artery Bypass - methods Female Humans Male Mammary Arteries - pathology Mammary Arteries - transplantation Mediastinum - radiation effects Mediastinum - surgery Medical sciences Middle Aged Postoperative Complications - etiology Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Surgery of the respiratory system |
title | Quality of Internal Thoracic Artery Grafts After Mediastinal Irradiation |
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