Effects of left internal mammary artery (LIMA) harvesting during coronary artery by-pass grafting surgery on benign breast diseases

Abstract

Aim: Coronary artery bypass surgery of the primary conduits employed in coronary artery bypass grafting surgery (CABG) is the left internal mammary artery (LIMA), which has garnered considerable attention due to its favorable characteristics and outcomes. There are not enough studies examining the relationship between benign breast diseases (BBD) and LIMA removal. This study is one of the pioneering studies investigating the effects of LIMA removal after bypass surgery in patients with benign breast diseases. This study aims to evaluate the effect of LIMA removal on benign breast diseases in female patients undergoing bypass surgery by analyzing pre- and post-operative breast imaging. Material and Methods: A total of 47 of 452 female patients who underwent bypass surgery between February 18, 2019, and December 31, 2021, were included in the study. All patients’ LIMA were harvested and evaluated, regarding any progression of benign breast diseases. Results: There was a significant difference between the Breast Imaging Reporting and Data System (BI-RADS) classes of the patients before and after CABG (p<0.001). While 40.4% of the patients were BI-RADS class 1 preoperatively, this rate decreased to 14.8% postoperatively. Class 2 level did not show a significant difference, while class 3 level increased from 8.5% to 31.9%. Correlation analysis results between pre-op and post-op BI-RADS classes and age and Body Mass Index (BMI) were analyzed, but no significant correlation value was found. The correlations between pre-op and post-op BI-RADS grades and Hormone Replacement Therapy (HRT) were significant. Conclusion: It can be concluded that LIMA harvesting during CABG surgery in female patients affects the occurrence of BBD. The change between the pre-op and post-op period was determined by mammography tests. It was shown that there was a significant change in BI-RADS scores on mammography after bypass surgery.

Keywords

• Left internal mammary artery
• coronary artery bypass grafting
• benign breast diseases
• BI-RADS
• mammography

Koroner arter by-pass greftleme ameliyatı sırasında sol internal mamaryen arteri (LIMA) kullanımının benign meme lezyonları üzerine etkileri

Abstract

Amaç: Koroner arter bypass cerrahisinde (KABG) olumlu özellikleri ve sonuçları nedeniyle en büyük ilgi gören ve en çok kullanılan graft sol internal mamaryen arterdir. (LIMA). KABG olan hastadalardaki iyi huylu meme hastalıkları (BBD) ile LIMA'nın kullanılması arasındaki ilişkiyi inceleyen yeterli çalışma yoktur. Bu çalışma benign meme hastalıkları olan hastalarda bypass ameliyatı sırasında LIMA çıkarılmasının etkilerini araştıran öncü çalışmalardan biridir. Bu çalışma, bypass ameliyatı geçiren kadın hastalarda ameliyat öncesi ve sonrası meme görüntüleme yöntemlerini analiz ederek LIMA çıkarılmasının iyi huylu meme hastalıkları üzerindeki etkisini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Çalışmaya 18 Şubat 2019 ile 31 Aralık 2021 tarihleri arasında KABG geçiren 452 kadın hastadan 47'si dahil edildi. Tüm hastalarda LIMA kullanıldı, bu hastalardaki iyi huylu meme hastalıklarının değişimi değerlendirildi. Bulgular: Hastaların KABG öncesi ve sonrası Meme Görüntüleme Raporlama ve Veri Sistemi (BI-RADS) sınıfları arasında anlamlı fark vardı (p<0,001). Ameliyat öncesi hastaların %40,4'ü BI-RADS sınıf 1 iken ameliyat sonrası bu oran %14,8'e düştü. 2. sınıf düzeyi önemli bir fark göstermezken, 3. sınıf düzeyi %8,5'ten %31,9'a yükseldi. Ameliyat öncesi ve sonrası BI-RADS sınıfları ile yaş ve Beden Kitle İndeksi (BKİ) arasındaki korelasyon analizi sonuçları analiz edildi ancak anlamlı bir korelasyon saptanmadı. Ameliyat öncesi ve sonrası BI-RADS dereceleri ile Hormon Replasman Tedavisi (HRT) arasındaki korelasyonlar anlamlıydı. Sonuç: Kadın hastalarda KABG ameliyatı sırasında LIMA kullanımının BBD oluşumunu etkilediği sonucuna varılabilir. Mamografi ile takip edilen hastalarda ameliyat öncesi ve sonrası dönem karşılaştırıldığında lezyonlarda değişim olduğunu belirlenedi. Bypass ameliyatı sonrası mamografide BI-RADS skorlarında anlamlı değişiklik olduğu gösterildi.

Keywords

• sol internal mamaryen arter
• koroner arter bypass greftleme
• benign meme lezyonları
• BI-RADS
• mamografi

References

1. 1. Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, et al. Influence of the Internal-Mammary-Artery Graft on 10-Year Survival and Other Cardiac Events. N Engl J Med. 1986 Jan 2;314(1):1–6.
2. 2. Cobanoglu A, Isbir S. Koroner Arter Bypass Cerrahisi. In: Pac M, Akcevin A, Aka S, Buket S, Sarioglu T, editors. Kalp ve Damar Cerrahisi. Ankara: Medikal&Nobel; 2004. p. 657–67.
3. 3. Seifert P. Cardiac Surgery. In: Rothrock J, McEwen D, editors. Alexander’s Care of the Patient in Surgery. St. Louis: Mosby; 2007. p. 971–1019.
4. 4. Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R, et al. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg [Internet]. 1999 [cited 2024 May 16];117(5):855–72. Available from: https://pubmed.ncbi.nlm.nih.gov/10220677/
5. 5. Sundt TM, Barner HB, Camillo CJ, Gay WA. Total arterial revascularization with an internal thoracic artery and radial artery T graft. Ann Thorac Surg [Internet]. 1999 [cited 2024 May 16];68(2):399–404. Available from: https://pubmed.ncbi.nlm.nih.gov/10475403/
6. 6. Jesinger RA. Breast anatomy for the interventionalist. Tech Vasc Interv Radiol [Internet]. 2014;17(1):3–9. Available from: http://dx.doi.org/10.1053/j.tvir.2013.12.002
7. 7. Endo M, Nishida H, Tomizawa Y, Kasanuki H. Benefit of bilateral over single internal mammary artery grafts for multiple coronary artery bypass grafting. Circulation. 2001 Oct 30;104(18):2164–70.
8. 8. Dion R, Glineur D, Derouck D, Verhelst R, Noirhomme P, Khoury G El, et al. Long-term clinical and angiographic follow-up of sequential internal thoracic artery grafting. Eur J Cardio-Thoracic Surg [Internet]. 2000;17(4):407–14. Available from: https://academic.oup.com/ejcts/article-abstract/17/4/407/438629

9. 9. Kurlansky P, Traad E, Galbut D, Zucker M, Ebra G. Efficacy of single versus bilateral internal mammary artery grafting in women: a long-term study. Ann Thorac Surg. 2001;71(6):1949–58.
10. 10. Amin AL, Purdy AC, Mattingly JD, Kong AL, Termuhlen PM. Benign Breast Disease. Surg Clin North Am. 2013;93(2):299–308.
11. 11. Garvican L, Grimsey E, Littlejohns P, Lowndes S, Sacks N. Satisfaction with clinical nurse specialists in a breast care clinic: questionnaire survey. BMJ. 1998;316(7136):976–7.
12. 12. Posso M, Alcántara R, Vázquez I, Comerma L, Baré M, Louro J, et al. Mammographic features of benign breast lesions and risk of subsequent breast cancer in women attending breast cancer screening. Eur Radiol [Internet]. 2022 [cited 2024 May 8];32(1):621–9. Available from: https://doi.org/10.1007/s00330-021-08118-y
13. 13. Castells X, Domingo L, Corominas JM, Torá-Rocamora I, Quintana MJ, Baré M, et al. Breast cancer risk after diagnosis by screening mammography of nonproliferative or proliferative benign breast disease: a study from a population-based screening program. Breast Cancer Res Treat. 2015;149:237–44.
14. 14. Karthik S, Fabri BM. Left internal mammary artery usage in coronary artery bypass grafting: a measure of quality control. Ann R Coll Surg Engl [Internet]. 2006 Jul [cited 2024 May 15];88(4):367–9. Available from: https://pubmed.ncbi.nlm.nih.gov/16834857/
15. 15. Goetz RH, Rohman M, Haller JD, Dee R, Rosenak SS. INTERNAL MAMMARY-CORONARY ARTERY ANASTOMOSIS: A Nonsuture Method Employing Tantalum Rings. J Thorac Cardiovasc Surg. 1961 Mar 1;41(3):378–86.
16. 16. Arslan G, Celik L, Cubuk R, Celik L, Atasoy MM. Internal Mammary Artery Anastomoses in Patients without Breast Lesions (BIRADS 1) and in Patients with Malignant Breast Lesions (BIRADS 6) on Magnetic Resonance Imaging (MRI). Polish J Radiol [Internet]. 2017 Nov 17;82:660–3. Available from: https://pubmed.ncbi.nlm.nih.gov/29657631/
17. 17. Gity M, Moghadam KG, Jalali AH, Shakiba M. Association of Different MRI BIRADS Descriptors With Malignancy in Non Mass-Like Breast Lesions. Iran Red Crescent Med J [Internet]. 2014 Dec 30 [cited 2024 Jun 5];16(12). Available from: https://pubmed.ncbi.nlm.nih.gov/25763248/
18. 18. Schipper RJ, Lobbes MBI, Dikmans RE, Beets-Tan RGH, Smidt ML, Boetes C. Bilateral analysis of the cross-sectional area of the internal mammary arteries and veins in patients with and without breast cancer on breast magnetic resonance imaging. Insights Imaging [Internet]. 2013 Apr 1 [cited 2024 Jun 5];4(2):177–84. Available from: https://pubmed.ncbi.nlm.nih.gov/23322271/
19. 19. Nam KJ, Choo KS, Jeon UB, Kim TU, Hwang JY, Yeom JA, et al. Comparison of diameters of ipsilateral and contralateral internal mammary arteries by breast MRI in patients with unilateral breast cancer. Jpn J Radiol [Internet]. 2016 Jun 1 [cited 2024 Jun 5];34(6):409–13. Available from: https://pubmed.ncbi.nlm.nih.gov/27012963/
20. 20. D’orsi C, Kopans D. Mammography interpretation: the BI-RADS method. Am Fam Physician [Internet]. 1997 [cited 2024 May 15];55(5):1548–51. Available from: https://elibrary.ru/item.asp?id=4795565
21. 21. Shadrin IY, Holmes DR, Behfar A. Left Internal Mammary Artery as an Endocrine Organ: Insights Into Graft Biology and Long-term Impact Following Coronary Artery Bypass Grafting. Mayo Clin Proc [Internet]. 2023 Jan 1 [cited 2024 May 16];98(1):150–62. Available from: https://pubmed.ncbi.nlm.nih.gov/36603943/
22. 22. Al Sayegh J, Alazhri J, Albadr S. First case report of bilateral breast necrosis following coronary artery bypass graft using left internal mammary artery. Breast J [Internet]. 2021 Nov 1 [cited 2024 May 16];27(11):832–7. Available from: https://pubmed.ncbi.nlm.nih.gov/34514671/
23. 23. Zuo HJ, Nan N, Yang HX, Wang JW, Song XT. Impact of Conventional Cardiovascular Risk Factors on Left Internal Mammary Artery Graft Disease. Front Cardiovasc Med. 2022;8.
24. 24. Dallan L, Dallan L, Neves Filho A, Jatene F. The use of internal mammary vein in coronary artery surgery. J Card Surg [Internet]. 2021 Jun 1 [cited 2024 May 16];36(6):2103–5. Available from: https://pubmed.ncbi.nlm.nih.gov/33682966/
25. 25. Güler A, Sahin M, M T, Yokusoglu M. Is internal mammary artery suitable for coronary artery bypass graft in pseudoxanthoma elasticum? Turkish J Thorac Cardiovasc Surg. 2012;20:904–6.