Use of internal mammary artery in myocardial revascularization after mediastinal irradiation

Abstract

Ten patients with radiation-associated proximal coronary artery disease underwent myocardial revascularization. In seven patients (group A) the internal mammary artery was used and in the other three (group B) only venous conduits were used. Except for mild adhesions between the pericardium and the epicardium, no unusual technical problems were encountered. In all patients in group A the internal mammary artery exhibited excellent flow, and histologic examination in two patients revealed a normal intima and media with only slight fibrosis of the adventitia. In two patients in group B, fibrosis of the internal mammary artery precluded its use, whereas the third patient had contraindications prohibiting use of the internal mammary artery. Long-term follow-up (range 6 to 72 months) revealed that one patient in group A died late of metastatic disease, and of the remainder (nine patients), seven were in New York Heart Association class I and two were in class II. Preoperative assessment of the internal mammary artery by angiography or, alternatively, B-mode imaging with Doppler spectrum analysis is recommended in patients with radiation-induced coronary artery disease who are scheduled to undergo myocardial revascularization with intended use of the internal mammary artery. In our experience, despite previous exposure to irradiation, the internal mammary artery should still be considered as a viable conduit for myocardial revascularization when preoperative assessment shows patency.