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Cardiac surgery
Original research article
Coronary artery bypass grafting in patients treated with thoracic radiation: a case–control study
  1. Erin Amanda Fender1,
  2. Pranav Chandrashekar1,
  3. Jackson J Liang2,
  4. Priyank R Dhar3,
  5. Terence T Sio4,
  6. John M Stulak5,
  7. Ryan J Lennon6,
  8. Joshua P Slusser6,
  9. Jonathan B Ashman4,
  10. Robert C Miller4,
  11. Joerg Herrmann1,
  12. Abhiram Prasad1 and
  13. Gurpreet S Sandhu1
  1. 1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Division of Cardiovascular Disease, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
  5. 5Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
  6. 6Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Erin Amanda Fender; fender.erin{at}mayo.edu

Abstract

Background and aim Thoracic radiation therapy (XRT) for cancer is associated with the development of significant coronary artery disease that may require coronary artery bypass grafting surgery (CABG). Contemporary acute surgical outcomes and long-term postoperative survival of patients with prior XRT have not been well characterised.

Methods This was a retrospective, single-centre study of patients with a history of thoracic XRT who required CABG and who were propensity matched against 141 controls who underwent CABG over the same time period. The objectives were to assess early CABG outcomes and long-term survival in patients with prior XRT.

Results Thirty-eight patients with a history of previous thoracic XRT underwent CABG from 1994 to 2013. The median time from XRT exposure to surgery was 7.9 years (IQR: 2.5–18.4 years). Perioperative adverse events were similar in the XRT group and controls; however, there was a trends lower utilisation of internal mammary artery (IMA) grafts in the XRT group (89%vs98%, P=0.13). After a median postoperative follow-up of 5.4 years (IQR 0.9–9.4 years), no difference in long-term all-cause mortality was observed.

Conclusion Patients with prior thoracic XRT who undergo CABG have similar long-term all-cause mortality compared with controls. Isolated CABG after thoracic XRT is not associated with higher perioperative complications, but IMA graft use may be limited by prior XRT.

  • coronary artery bypass graft surgery
  • external beam radiation therapy
  • radiotherapy
  • radiation heart disease

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2017-000766

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    Footnotes

    • Contributors All participants made substantive contributions to the research project and writing of this article and are included as authors.

    • Competing interests None declared.

    • Patient consent Retrospective study. Patients signed institutional consent forms at the time medical care was provided.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available. Requests for data sharing will be reviewed by the institution and granted in accordance with Mayo Clinic’s data sharing policies.