{"id":"c7a9f1192c0f","type":"article","url":"https://hartvaat.nl/2026/04/24/ita-bypass-veilig-bij-patienten-met-eerdere-mediastinale-bestraling-maryland-coh/","title":"ITA-bypass veilig bij patiënten met eerdere mediastinale bestraling: Maryland-cohort van 29.206","title_en":"Safety of internal thoracic artery use in patients with prior mediastinal radiation undergoing coronary artery bypass grafting: a Maryland statewide propensity-matched analysis","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart","doi":"http://heart.bmj.com/cgi/content/short/112/10/557?rss=1","source_url":"https://doi.org/http://heart.bmj.com/cgi/content/short/112/10/557?rss=1","authors":["Zhou","A. L.","Chinedozi","I. D.","Holmes","S. D.","Gammie","J. S.","Patel","D.","Akbar","A. F.","Alejo","D.","Lawton","J.","Whitman","G.","Salenger","R.","Briscoe","J. B.","Darby","Z. E.","Cameron","D.","Wang","H.","on behalf of the Maryland Cardiac Surgery Quality Initiative (MCSQI)","S Gammie","Alejo","Lawton","Whitman","Salenger","Cameron","Wang"],"significance":5,"published":"2026-05-22","source_date":"2026-04-24","image":"https://hartvaat.nl/global/img/54665943e7e6.webp","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/","https://hartvaat.nl/kennis/kleplijden/mitralisregurgitatie/"],"congress":"","summary_en":"Retrospective cohort from the Maryland Cardiac Surgery Quality Initiative database: 29,206 patients who underwent CABG with internal thoracic artery (ITA) grafting between July 2011 and March 2023. 294 patients (1%) had a history of mediastinal radiation. After 1:10 propensity matching, there was no significant difference in the primary composite of operative mortality and deep sternal wound infection (2% vs 3%; p=0.53) or in secondary outcomes (infectious complications, length of stay, 30-day readmission). Findings challenge the prevailing concern about ITA use in irradiated patients and argue against excluding them from arterial revascularization strategies.","created":"2026-07-03T10:32:57Z","updated":"2026-07-03T13:31:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Retrospectief cohort uit de Maryland Cardiac Surgery Quality Initiative-database: 29.206 patiënten die tussen juli 2011 en maart 2023 een CABG ondergingen met arteria thoracica interna (ITA)-graft. 294 patiënten (1%) hadden een voorgeschiedenis van mediastinale bestraling. Na propensity matching (1:10) was er geen significant verschil in de primaire samengestelde uitkomst van operatieve mortaliteit en diepe sternale wondinfectie (2% vs 3%; p=0,53), en evenmin in secundaire uitkomsten (infectieuze complicaties, opnameduur, 30-daagse heropname). De bevindingen weerleggen de gangbare zorg over ITA-gebruik bij bestraalde patiënten en pleiten ervoor deze groep niet langer uit te sluiten van arteriële revascularisatie.","abstract_original":"Background\n

The safety of internal thoracic artery (ITA) grafting in patients undergoing coronary artery bypass grafting (CABG) with prior mediastinal radiation remains controversial due to concerns regarding compromised sternal perfusion and radiation-induced injury. This study evaluated whether prior mediastinal radiation is associated with adverse perioperative outcomes in patients undergoing CABG with ITA grafting.

\n\nMethods\n

We conducted a retrospective cohort study using the Maryland Cardiac Surgery Quality Initiative (MCSQI) database. A total of 29 206 patients who underwent CABG with ITA use between 1 July 2011 and 31 March 2023 were analysed. Patients with and without prior mediastinal radiation were propensity-matched (1:10) using the nearest neighbour method. The primary outcome was the composite of operative mortality and deep sternal wound infection (DSWI). Secondary outcomes included other infectious complications, major morbiditie"}