Durability of Internal Mammary Artery Grafts in Cardiac Surgery Patients with Prior Mediastinal Radiation
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0129
Submission Type:
Abstract Submission
Authors:
Adham Makarem (1), Emmanuel Odekunle (2), Patrick Udeh (1), Zoe Laddis (1), Carly Liquori (1), Jack Guiry (3), Boateng Kubi (4), Niyi Odewade (5), Jordan Bloom (1), Motahar Hosseini (1), Arminder Jassar (1), Antonia Kreso (6), Nathaniel Langer (7), Serguei Melnitchouk (1), Eriberto Michel (1), Alireza Rabi (1), David D'Alessandro (8), Sary Aranki (9), George Tolis (10), Ashraf Sabe (11), Thoralf Sundt (12), Akinobu Itoh (10), Asishana Osho (1)
Institutions:
(1) Massachusetts General Hospital, Boston, MA, (2) N/A, N/A, (3) Massachusetts General Hospital, Charlottesville, VA, (4) Massachusetts General Hospital, Everett, MA, (5) Brigham & Women's Hospital, Brighton, MA, (6) Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, (7) Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, (8) Harvard University Medical School, Weston, MA, (9) N/A, Boston, MA, (10) Brigham and Women's Hospital, Boston, MA, (11) Brigham and women's hospital, Boston, MA, (12) Harvard University, Boston, MA
Submitting Author:
Adham Makarem
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Massachusetts General Hospital
Massachusetts General Hospital
Co-Author(s):
Emmanuel Odekunle
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N/A
N/A
Patrick Udeh
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Massachusetts General Hospital
Massachusetts General Hospital
Zoe Laddis
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Massachusetts General Hospital
Massachusetts General Hospital
Carly Liquori
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Massachusetts General Hospital
Massachusetts General Hospital
Jack Guiry
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Massachusetts General Hospital
Massachusetts General Hospital
Boateng Kubi
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Massachusetts General Hospital
Massachusetts General Hospital
Niyi Odewade
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Brigham & Women's Hospital
Brigham & Women's Hospital
Jordan Bloom
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Massachusetts General Hospital
Massachusetts General Hospital
Motahar Hosseini
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Massachusetts General Hospital
Massachusetts General Hospital
*Arminder Jassar
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Massachusetts General Hospital
Massachusetts General Hospital
Antonia Kreso
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Division of Cardiac Surgery, Massachusetts General Hospital
Division of Cardiac Surgery, Massachusetts General Hospital
Nathaniel Langer
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Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School
Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School
*Serguei Melnitchouk
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Massachusetts General Hospital
Massachusetts General Hospital
Eriberto Michel
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Massachusetts General Hospital
Massachusetts General Hospital
Alireza Rabi
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Massachusetts General Hospital
Massachusetts General Hospital
*David D'Alessandro
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Harvard University Medical School
Harvard University Medical School
*Sary Aranki
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N/A
N/A
*George Tolis
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Brigham and Women's Hospital
Brigham and Women's Hospital
Ashraf Sabe
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Brigham and women's hospital
Brigham and women's hospital
*Thoralf Sundt
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Harvard University
Harvard University
*Akinobu Itoh
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Brigham and Women's Hospital
Brigham and Women's Hospital
Asishana Osho
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Massachusetts General Hospital
Massachusetts General Hospital
Presenting Author:
Adham Makarem
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Massachusetts General Hospital
Massachusetts General Hospital
Abstract:
Objective: As the number of patients with prior mediastinal radiation continues to rise, managing radiation-associated coronary artery disease has become an increasingly common and timely challenge. Given concerns about late radiation effects on arterial conduit patency, the optimal graft choice for CABG remains uncertain. This study evaluated the durability of internal mammary artery (IMA) grafts and long-term outcomes in this high-risk population.
Methods: We retrospectively identified all patients who underwent isolated CABG at Mass General Brigham with a history of mediastinal radiation. A 1:3 propensity score–matched cohort without prior mediastinal radiation was constructed based on demographics, comorbidities, and operative characteristics. IMA graft patency was assessed among patients who underwent postoperative coronary angiography, and long-term survival was evaluated using Kaplan–Meier analysis.
Results: A total of 141 patients with prior mediastinal radiation were matched to 423 controls, with balanced baseline characteristics (standardized mean differences <0.1 for all covariates). IMA utilization was lower in the mediastinal radiation group compared with controls (93.3% vs 97.6%, p=0.017), most commonly due to prior radiation or previous cardiac surgery. Radial artery and venous conduit use did not differ significantly between groups. Follow-up coronary angiography was performed more frequently among patients with prior radiation (21.4% vs 12.0%,p = 0.006). Among those who underwent angiography, IMA graft patency (<50% stenosis) was lower in the radiation group (63.3% vs 80.0%) but did not reach statistical significance (p = 0.331). Complete occlusion occurred more often in the radiation cohort (26.7% vs 14.0%). Long-term survival was significantly reduced in the radiation group, with mortality rates of 9.2% vs 3.8% at 1 year (p=0.0113) and 25.5% vs 16.6% at 10 years (p=0.0180). Kaplan–Meier analysis demonstrated inferior overall survival among radiation-exposed patients (HR=1.69, 95% CI 1.14–2.49,p=0.0088).
Conclusion: In this dual-center propensity-matched analysis, prior mediastinal radiation was associated with lower IMA utilization, a trend toward reduced graft patency, and worse long-term survival. Although angiographic follow-up was symptom-driven, these findings raise important questions about the long-term durability of IMA grafts. Practitioners might consider alternative conduit strategies in patients with a history of radiation.
Methods: We retrospectively identified all patients who underwent isolated CABG at Mass General Brigham with a history of mediastinal radiation. A 1:3 propensity score–matched cohort without prior mediastinal radiation was constructed based on demographics, comorbidities, and operative characteristics. IMA graft patency was assessed among patients who underwent postoperative coronary angiography, and long-term survival was evaluated using Kaplan–Meier analysis.
Results: A total of 141 patients with prior mediastinal radiation were matched to 423 controls, with balanced baseline characteristics (standardized mean differences <0.1 for all covariates). IMA utilization was lower in the mediastinal radiation group compared with controls (93.3% vs 97.6%, p=0.017), most commonly due to prior radiation or previous cardiac surgery. Radial artery and venous conduit use did not differ significantly between groups. Follow-up coronary angiography was performed more frequently among patients with prior radiation (21.4% vs 12.0%,p = 0.006). Among those who underwent angiography, IMA graft patency (<50% stenosis) was lower in the radiation group (63.3% vs 80.0%) but did not reach statistical significance (p = 0.331). Complete occlusion occurred more often in the radiation cohort (26.7% vs 14.0%). Long-term survival was significantly reduced in the radiation group, with mortality rates of 9.2% vs 3.8% at 1 year (p=0.0113) and 25.5% vs 16.6% at 10 years (p=0.0180). Kaplan–Meier analysis demonstrated inferior overall survival among radiation-exposed patients (HR=1.69, 95% CI 1.14–2.49,p=0.0088).
Conclusion: In this dual-center propensity-matched analysis, prior mediastinal radiation was associated with lower IMA utilization, a trend toward reduced graft patency, and worse long-term survival. Although angiographic follow-up was symptom-driven, these findings raise important questions about the long-term durability of IMA grafts. Practitioners might consider alternative conduit strategies in patients with a history of radiation.
ADULT CARDIAC:
Coronary Artery Disease
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