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DOI: 10.1055/s-0029-1191326
Long-term outcome of CABG – patients after previous mediastinal irradiation due to cancer. A retrospective survival-rate-analysis of 125 patients within 14 years
Objectives: The number of patients with mastectomy or Hodkin's/non-Hodkin's- Lymphoma and prior mediastinal irradiation requiring CABG is increasing. Aim of the study was to review the long term outcome of this specific,higher risk population.
Methods: Between1/93 and 9/06 125 patients with previous mastectomy or Hodkin's/non-Hodkin's-Lymphoma and mediastinal irradiation underwent CABG (88) or CABG+VR (37), 62 patients received bilateral-ITA-grafting, 43 unilateral ITA and 20 patients veins (Group A). Postoperative complications/mortality were analyzed and compared to a propensity score pair-matched control group of 125 patients receiving CABG or CABGVR within the same period (group B).
Postoperative mortality and clinical outcome were evaluated. Follow-up ranged from 0.1 to 13.8 years (mean 6.2±3.7) and was complete for 92%.
Results: Perioperative mortality revealed 3.2% (Group A) versus 5.6% (Group B). Actuarial survival after 3, 5, 8 and 10 years was: Group A 88.9%, 80.3, 68.3% and 57.4 versus Group B 87.8%, 81.5%, 71.7% and 70.2% (p<0.03). In Group A sternal instability occurred in 3.2% versus 0% (Group B). Histomorphological examinations did not identify severe irradiation induced fibrosis of ITA grafts.
Conclusion: Clinical outcome and survival-rates during the first 8 years were not different between patients after mediastinal irradiation compared to a propensity pair-matched control group without previous irradiation.
Despite the slightly enhanced peri-operative risk of sternal instabilties, excellent perioperative and mid- to long-term survival rates could be documented in this high risk population. Comparable survival rates and absence of irradiation induced ITA graft damage might encourage not to exclude these patients from the benefit of one or both ITAs.