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J Thorac Cardiovasc Surg 2007;133:411-413
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

Dr Thoralf M. Sundt (Rochester, Minn). Well done, Dr Chang. A very nicely presented article. My colleagues and I from the other clinic share your concern about both the short- and long-term outcomes of these patients. We are seeing more and more of these folks, and it is really a tough population with which to deal. If I understand your data correctly, given the choice from the menu of radiation-treated patients on whom to operate, I should pick the tangential ones and leave the extensive ones to my junior colleagues. Unfortunately, most of the time, we have to deal with the cases that we are served up, and accordingly, I have some specific questions for you that are perhaps more relevant as we face patient by patient in the clinic.

With regard to the individuals having tangential radiation, you mentioned some of this in your article, which I appreciate you sending to me. Could you comment on the use of the ITA ipsilateral to the radiation? I have quite frankly not used the ITA on the side of the radiation; this is almost an absolute rule for me. That is probably the only population in which I do not use the ITA to the left anterior descending coronary artery, and I would like your comments. What is your practice, and do you have any data about late ITA patency if the ITA has been irradiated?

A second question, focusing more on the patients receiving extensive radiation, who are the more problematic, you present something of a paradox. You argue for a definitive operation and I agree with that, the redo—as miserable as the first operation is—the redo is really, really tough, and yet ischemic time was one of the risk factors, so how do you balance that? What are . . . [Full Text of this Article]

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Cardiac surgery after mediastinal radiation: Extent of exposure influences outcome

Albert S.Y. Chang, Nicholas G. Smedira, Catherine L. Chang, Monica M. Benavides, Ulf Myhre, Jingyuan Feng, Eugene H. Blackstone, and Bruce W. Lytle
J. Thorac. Cardiovasc. Surg. 2007 133: 404-413. [Abstract] [Full Text] [PDF]