Postoperative Chest Pain Research Articles

Laparoscopic Cardiomyotomy for Achalasia: Clinical Outcomes Beyond 5 Years

BackgroundLaparoscopic cardiomyotomy is the most common surgical procedure for the treatment of achalasia, although few reports describe long-term surgical outcomes. MethodsThe outcomes for 155 patients who underwent a laparoscopic cardiomyotomy with anterior partial fundoplication more than 5 years ago (July 1992 to May 2004) were determined. Patients were followed prospectively at yearly time points using a structured questionnaire which evaluated symptoms of dysphagia, reflux, side-effects, and overall satisfaction with the clinical outcome. ResultsClinical data were available for 125 patients. Thirteen patients died within 5 years of surgery, four were unable to complete the questionnaire, and one developed esophageal squamous cell carcinoma. Nine patients were lost to follow-up, and three would not answer the questionnaire (92.2% late follow-up). Postoperative dysphagia, odynophagia, chest pain, and heartburn was significantly improved at 1 year, 5 years, and late (5+ years) follow-up, with outcomes stable beyond 12 months. Seventy-seven percent of patients reported a good or excellent result (minimal or no symptoms) at 5 years and 73% at late follow-up. At late follow-up, 90% considered they had made the correct decision to undergo surgery. ConclusionsAt minimum 5 years follow-up, laparoscopic cardiomyotomy for achalasia achieves effective and durable relief of symptoms, and most patients are satisfied with the outcome.

A survey of post‐sternotomy chronic pain following cardiac surgery

Coronary artery bypass grafting (CABG) is a common surgical procedure with over 19 000 cases carried out in the UK in 2006/07. Persistent chest wall pain following cardiac surgery was termed Post-CABG Pain Syndrome (PCPS) in 1989 [1]. It has a reported incidence of up to 56% and is recognised as an important postoperative complication [2]. Currently PCPS is not considered in our patients’ consent procedure. We undertook a survey of 100 CABG patients in order to determine the incidence of PCPS in our population. We obtained local ethics committee approval for this structured questionnaire. One hundred consecutive CABG patients were contacted by telephone 8–10 months after their operation. Post CABG Pain Syndrome was defined using previously published criteria [1, 2]: postoperative chest pain (right, left or midline) persisting for more than 3 months. The pain was qualified in terms of its site, nature, severity, neuropathic component, need for analgesics and effect on sleep and activities of daily living. Data were analysed using Fisher’s exact test with Bonferroni correction for multiple comparisons and unpaired Student’s t-test. A separate questionnaire completed by cardiac surgeons asked about their perceived incidence of PCPS. Completed datasets were available for 79 patients; 46% patients met the criteria for a diagnosis of PCPS. Analysis revealed statistically significant higher mean pain scores on ICU (p = 0.012), the ward (p = 0.046) and on discharge (p = 0.024) in the patients with PCPS. Subgroup analysis of other previously reported risk factors for PCPS failed to reach statistical significance. The cardiac surgeons estimated the incidence of PCPS to be 0.01–5%. This study reveals a high incidence (46%) of PCPS in our population that is greatly underestimated by our cardiac surgeons. Our data show that increased postoperative pain is a risk factor for developing PCPS. This is consistent with evidence following other types of surgery [3]. Limitations of this study include selection bias and a small sample size. We conclude that PCPS is a significant when seeking patients’ consent. We intend to investigate the link between increased complication that should be included postoperative pain and PCPS further.

A case of simultaneous pulmonary embolism and acute myocardial infarction secondary to a previously undiagnosed patent foramen ovale

We describe a 79-year-old male with recurrent high-grade liposarcoma who developed postoperative chest pain, dyspnea, and hypoxia suspicious for acute pulmonary embolism (PE). However, electrocardiogram (ECG) was suggestive of an acute ST-elevation myocardial infarction (MI). Heparin was initiated and emergent coronary angiography was performed, which demonstrated a "cutoff sign" in the distal left anterior descending artery (LAD) consistent with coronary embolism. A patent foramen ovale (PFO) and bilateral pulmonary emboli were subsequently identified. It was concluded that the patient had suffered an acute PE, with a portion of clot traversing the PFO and entering the LAD, resulting in a simultaneous acute ST-elevation MI. While the case described is rare, the underlying anatomical variant is common and may have practical significance. We discuss the literature regarding PFO with acute PE and paradoxical emboli.

Intramural haematoma of the oesophagus presenting as an unusual complication of endotracheal intubation

Intramural haematoma of the oesophagus is an uncommon and under-recognized condition. It may mimic other causes of chest pain, haematemesis, or dysphagia, and hence pose a diagnostic challenge. We report a case of an unusual presentation of intramural haematoma of the oesophagus occurring as a presumed complication of endotracheal intubation. It was disguised as acute onset post-operative chest pain, and resolved with conservative management. Awareness of this uncommon complication is important to allow rapid and timely diagnosis and management. We review the literature, causes and imaging features of this condition.

The study on freezing intercostal nerves for the relief of postoperative chest pain

To explore the best freezing time and the optimum analgesia modality. In dogs, intercostal nerves were froze at -70 degrees C at different time including 30, 60, 90, 120, 180 s. Samples were got at the operative day, in 10 days and 60 days respectively, then carried on the pathology exam. In clinical study, 150 patients undergoing thoracotomy were randomly designated into 5 groups, all patients were recorded the heart rate, blood pressure, SO2, VAS, the dosage of dolantin, and observed the complications and side effects. At operative day, the freezing nerves appeared brown print macroscopically, and presented degeneration, necrosis of the nerve fiber microscopically with more than 90 s. After 10 days, nerves with more than 90 s became thinner than normal. After 60 days, all nerves had no obvious differentiation than normal. In clinical study, both 90 s group and 90 s with PCIA group were significantly better than 60 s group or PCIA group; The VAS of 90 s with PCIA group was significantly lower than 90 s group but had more side effects such as vomiting, nausea. At -70 degrees C, the freezing time should be no less than 90 s. The freezing intercostal nerves can safely and effectively relieve postoperative chest pain. The effect of analgesia of 90 s with PCIA group is the best, but has many side effects.

Non-invasive imaging of vein grafts with multislice computed tomography

BACKGROUND: Multislice computed tomography (MSCT)-angiography is a new, emerging cardiovascular imaging modality. METHODS: This article reviews the "essentials" of venous bypass graft imaging by using MSCT, including the basic technical principles of MSCT, the radiological appearance of vein grafts and currently available literature. RESULTS: Multislice computed tomography (MSCT)-angiography allows an accurate evaluation of coronary bypass graft patency. Complete graft occlusion can be detected with a high diagnostic accuracy. However, detection and quantification of distal anastomosis stenosis is limited by MSCT when compared with invasive angiography due to limited spatial resolution and/or in the presence of metallic surgical clips. Vein graft disease can be diagnosed at early stages by imaging of non-calcified or calcifying plaques. CONCLUSIONS: Non-invasive multislice computed tomography (MSCT)-angiography can be used as "gatekeeper" in patients in whom invasive angiography is not the modality of first choice (e.g. atypical angina pectoris; inconclusive or equivocal or borderline positive ECG-stress test) or in patients who are at high risk for invasive catheter intervention in order to determine bypass graft patency. MSCT can be also applied for the evaluation of non-specific post-operative chest pain in patients after coronary bypass surgery, because extra-cardiac pathologies such as haematoma, abscess formation, pneumothorax, pulmonary embolism or sternal bone infections can be assessed simultaneously.

Laparoscopic hiatal hernia repair with human acellular dermal matrix patch: our initial experience

Background The laparoscopic repair of large hiatal hernia followed by an antireflux procedure is currently the gold standard therapy for gastroesophgeal reflux disease. However, it is recognized that recurrent hiatal herniation and wrap migration are major sources of operative failures in these patients. Some have described a reduction of such events with the placement of nonbiodegradable prosthetic patches over the primary cruroplasty. This prosthetic material may be associated with transesophageal and gastric erosions and a higher rate of postoperative dysphagia and chest pain when compared with simple suture cruroplasty alone. The aim of this study is to compare hiatal closure with a biodegradable patch (acellular dermal matrix) and simple suture curaplasty in patients undergoing laparoscopic antireflux surgery. Methods A total of 44 patients were prospectively enrolled in this study. Twenty-two consecutive patients undergoing large hiatal hernia repair (>5 cm) and fundoplication with primary suture cruroplasty only (group 1) were compared with 22 consecutive patients undergoing the same procedure with suture cruroplasty reinforced with an onlay acellular dermal matrix patch (group 2). The 2 groups were compared with regards to demographics, size of the hiatal hernia, pre- and postoperative symptom scores, pH studies, operative times, and hiatal hernia recurrence. Results Patients in both groups were well matched by age, weight, height, and size of hiatal hernia. There were similar preoperative values in esophageal manometry, 24-hour pH monitoring, and symptom scoring in both groups. Average operative time was 108 minutes in group 1 and 121 minutes in group 2. There were no major complications in either group. The median period of hospitalization was 1 day in both groups. Postoperative pH studies and symptoms score data were significantly improved in both groups. There was no significant difference in postoperative symptoms scores for dysphagia between the 2 groups. Two patients (one in each group) underwent esophageal dilatation for mild dysphagia postoperatively. In group 1, 2 patients (9%) had Nissen failure with hiatal hernia recurrences 6 months after surgery. There were no recurrences for the follow-up period in group 2. Conclusions Our early results suggest that hiatal hernia repair reinforced with an acellular dermal matrix patch may reduce the incidence of recurrent herniation and wrap migration. In addition, the increase in postoperative dysphagia, chest pain, and esophageal erosions associated with nondegradable mesh has not been observed in those with an acellular dermal matirx patch to this point in our follow up. However, future investigation of the material for this particular application as well as longer follow-up is necessary.

Case Reports: Polymethylmethacrylate Lung Embolus after Limb-salvage Surgery of the Distal Femur

Limb-salvage surgery for malignant tumors frequently involves reconstruction with an endoprosthesis anchored to bone by using third-generation cementing techniques. A 10-year-old boy with osteosarcoma had a pulmonary embolus caused by polymethylmethacrylate after having limb-salvage surgery that used high-pressure cementing techniques. He experienced transient postoperative chest pain, and a new wedge-shaped radiodense pulmonary lesion appeared on a computed tomography scan of the chest. A thoracotomy for resection of suspected metastatic osteosarcoma revealed a pulmonary infarct caused by cement embolization. Awareness of this potential complication should prompt investigation of possible pulmonary embolism and may prevent unnecessary thoracotomy.

Additional Minocycline Pleurodesis after Thoracoscopic Surgery for Primary Spontaneous Pneumothorax

Ipsilateral recurrence rates of spontaneous pneumothorax after video-assisted thoracoscopic surgery are higher than rates after open thoracotomy. This study was conducted to determine whether additional minocycline pleurodesis would be effective in diminishing recurrence after video-assisted thoracoscopic surgery treatment of primary spontaneous pneumothorax. Between June 2001 and February 2004, 202 patients with primary spontaneous pneumothorax were treated by conventional or needlescopic video-assisted thoracoscopic surgery. The procedures included resection of blebs and mechanical pleurodesis by scrubbing the parietal pleura. After the operation, patients were randomly assigned to additional minocycline pleurodesis (103 patients) or to observation (99 patients). Patients in the minocycline group had higher intensity chest pain and required a higher accumulated dose of meperidine. Short-term results showed that the two groups had comparable chest drainage duration, postoperative hospital stay, and complication rates. Patients in the minocycline group demonstrated a trend of decreased rate of prolonged air leaks (1.9 vs. 6.1%, p = 0.100). After a mean follow-up of 29 mo (12-47 mo), recurrent ipsilateral pneumothorax was noted in two patients in the minocycline group and eight patients in the observation group (p = 0.044 by the Kaplan-Meier method and log-rank test). Postoperative long-term residual chest pain and pulmonary function were comparable in both groups. Although associated with intense immediate chest pain, additional minocycline pleurodesis is a safe and convenient procedure that can reduce the rate of ipsilateral recurrence after thoracoscopic treatment for primary spontaneous pneumothorax.

Wound retraction system for lung resection by video-assisted mini-thoracotomy

Wound retraction system (WR; Alexis Wound Retractor, Applied Medical, CA, USA), designed for laparoscopic abdominal surgery, is instrumental in offering retraction and protection when an organ or specimen requires removal through a small incision. We performed lobectomy or segmentectomy with systematic lymph nodes dissection by video-assisted mini-thoracotomy for patients with primary lung cancer using this tool. This technique was used for elective operations in 24 men and 10 women; the length of major skin incision was 6.5+/-0.7 cm. The operative views and the ease of using endoscopic instruments were good. Only two patients required initial pleurectomy for pleuro-pulmonary adhesions before using WR. There were no patients with severe postoperative chest pain, wound infection and contamination.

Clinical Study of Freezing Intercostal Nerves in Preventing the Post-thoracotomy Chest Pain

目的 探讨减轻和消除开胸术后切口疼痛的方法.方法对100例后外侧开胸手术的病人随机分组,研究组和对照组各50例.研究组病人常规手术后行冷冻切口及切口为上下各一肋间及放置引流管的肋间神经根部,冷冻时间为90秒,根据视觉模拟评分法(VAS)观察术后切口疼痛以及记录使用哌替啶针的用量,术后随访3～6个月.对照组病人除不用冷冻治疗外,其他同研究组.结果研究组止痛效果满意,总的有效率(0～6级)为92%,平均VAS评分2.12,使用哌替啶针平均40.0mg/例;对照组总的止痛有效率(0～6级)为24%,平均VAS评分7.54,使用哌替啶针平均205.0mg/例.两组差异有非常显著意义(P＜0.01).术后随诊3～6个月,两组病人切口处感觉无明显差别.结论肋间神经冷冻能有效预防开胸术后切口疼痛。

Ten year experience of bioabsorbable mesh support in pectus excavatum repair

Introduction. We reviewed 10 years experience in the treatment of this deformity using a retro-sternal bioabsorbable mesh in place of a metallic device to lift and stabilise the sternum. Moreover, the mesh supports the thoracic and upper abdominal wall reconstruction. Materials and methods. From January 1990 to December 2000, in our Thoracic Surgery Unit, 65 patients with PE were assessed for surgical repair, mean age 16± 3.5 years, fronto sagittal thoracic index (FSTI) 0.21, ranging from 0.15–0.33. Twenty-three of them underwent surgical correction after initial assessment, 22 were deferred and sent to physiotherapy. At a subsequent assessment, five of the patients sent to physiotherapy were deemed to require surgery. Results. Of the 28 patients who underwent surgery, 2 (10%) presented a mild recurrence of PE after 1 year (0.30<FSTI>0.34), meanwhile all other patients maintained a FSTI>0.34. For all patients the improvement in FSTI was statistically significant, p=0.001. Patients satisfaction after 24 months was thus shared: excellent 18 patients (65%), good seven patients (25%), fair one patient (3.5%) and poor two patients (7%). No major complications were observed in preoperative period. Patients mobilisation was soon achieved thanks to the postoperative pain control and the absence of retro-sternal metallic support. Conclusions. The introduction of bioabsorbable mesh in the Robicsek technique is a safe procedure related to a high percentage of success. The high tolerance of the material reduces the inflammatory reaction. Moreover, the procedure prevents patients from having complications caused by retro-sternal device dislodgment, avoiding a second intervention for device reposition and reducing the postoperative chest pain achieving an early patient mobilisation. In the end a complete reconstruction of the upper abdomen wall has been produced.

Chest pain after partial upper versus complete sternotomy for aortic valve surgery

Objective — The aim of this study was to evaluate pain and pulmonary function after partial upper versus complete sternotomy for aortic valve surgery.Methods and results — In a prospective study of 31 adult patients, 15 individuals underwent aortic valve replacement via partial upper sternotomy, and 16 patients were operated on by means of a full median sternotomy. Chest pain was assessed at rest, after spirometry and coughing, using the visual analogue scale and a structured questionnaire. Forced expiratory volume at 1 second and forced vital capacity were measured by a hand-held spirometer. Minimal-access patients had less postoperative pain and improved pulmonary function in comparison with conventional aortic valve replacement. After partial upper sternotomy, the postoperative chest pain was confined to the sternal area, while after standard sternotomy a more generalized chest pain occurred. Differences in pain scores could still be demonstrated one month after discharge.Conclusions — This study suggests that partial upper sternotomy improves pulmonary function and reduces pain in comparison with standard full sternotomy.

Laparoscopic Anterior Esophageal Myotomy and Toupet Fundoplication for Achalasia

Achalasia is an esophageal motility disorder characterized by the failure of lower esophageal sphincter relaxation and the absence of esophageal peristalsis. The purpose of this study was to evaluate the clinical outcomes of patients undergoing laparoscopic esophageal myotomy and Toupet fundoplication for achalasia. A 9-cm myotomy was performed in most cases extending 7 cm above and 2 cm below the gastroesophageal junction. Severity of dysphagia, heartburn, chest pain, and regurgitation was graded preoperatively and postoperatively using a five-point symptomatic scale (0-4). Patients also graded their outcomes as excellent, good, fair, or poor. Between December 1995 and November 2000 a total of 49 patients (23 male, 26 female) with a mean age of 44.3 years (range 23-71 years) were diagnosed with achalasia. Mean duration of symptoms was 40.2 months (range 4-240 months). Thirty-seven patients (76%) had had a previous nonsurgical intervention or combinations of nonsurgical interventions [pneumatic dilation (23), bougie dilation (five), and botulinum toxin (19)], and two patients had failed esophageal myotomies. Forty-five patients underwent laparoscopic esophageal myotomy and Toupet fundoplication. Two patients received laparoscopic esophageal myotomies without an antireflux procedure, and two were converted to open surgery. One patient presented 10 hours after a pneumatically induced perforation and underwent a successful laparoscopic esophageal myotomy and partial fundoplication. Mean operative time was 180.5 minutes (range 145-264 minutes). Mean length of stay was 1.98 days (range 1-18 days). There were five (10%) perioperative complications but no esophageal leaks. There was a significant difference (P < 0.05) between the preoperative and postoperative dysphagia, chest pain, and regurgitation symptom scores. All patients stated that they were improved postoperatively. Eighty-six per cent rated their outcome as excellent, 10 per cent as good, and 4 per cent as fair. Laparoscopic anterior esophageal myotomy and Toupet fundoplication effectively alleviates dysphagia, regurgitation, and chest pain accompanying achalasia and is associated with high patient satisfaction, a rapid hospital discharge, and few complications.

Using postoperative cardiac Troponin-I (cTi) levels to detect myocardial ischaemia in patients undergoing vascular surgery

Background. Cardiac complications occur commonly in vascular surgery patients. Diagnosis of cardiac complications is difficult because of the inaccuracies associated with traditional cardiac enzyme measurements. CTi, a highly sensitive and specific marker of myocardial injury, may be able to detect cardiac complications with greater ease and accuracy.Methods. The study prospectively examined 100 consecutive patients who underwent major vascular surgery between 6/7/98 and 31/12/98 at the Royal Brisbane Hospital. Daily measurements of cTi, creatine kinase (CK), creatine kinase MB (CKMB), CKMB index, renal function and haemoglobin were taken for three postoperative days. One postoperative electrocardiograph (ECG) was taken. An extensive cardiac history was taken. Intraoperative and postoperative events were recorded.Findings. There were 100 patients. 18 patients (18%) had a cTi elevation. On the basis of classical diagnostic criteria, 15 patients (15%) suffered one or more cardiac complication (either myocardial infarction, congestive cardiac failure, unstable angina or atrial fibrillation). One patient (1%) who had a cTi elevation died. CTi elevation occurred in five patients (5%) who were not diagnosed with cardiac complications based on traditional criteria. Despite not meeting specific diagnostic criteria for cardiac complications, all patients showed signs and symptoms that could be attributed to myocardial ischaemia. Every patient who developed congestive cardiac failure or atrial fibrillation had a cTi elevation. A Chi-square analysis revealed a significant association between cTi elevation and postoperative cardiac complications. Four variables contributed small but significant amounts of unique variance to the prediction of peak cTi on linear regression analysis. These were peak CKMB index, postoperative congestive cardiac failure, postoperative chest pain and postoperative cardiac complications.Conclusions. Routine cTi monitoring of postoperative vascular patients would be an effective and inexpensive way to detect patients with cardiac complications. The relationship between postoperative cTi elevation and significant coronary artery disease remains to be shown.

Thoracoscopy as a Nonpharmacotherapeutic Research Modification for Limiting Postoperative Chest Pain

Diminished tissue injury and shortened clinical recovery are benefits of using an endoscopic approach for patients needing operative procedure. In the course of developing an experimental model requiring procurement of topographically precise lung biopsy specimens, we sought to apply thoracoscopy as a research alternative to thoracotomy. In addition, we investigated the influence of thoracoscopy on postprocedure recovery practices using rabbits divided into four treatment groups. Rabbit groups 1 and 2 underwent thoracoscopy and lung biopsy while maintained by one-lung anesthesia. Additionally, group 2 had ketoprofen and bupivacaine HCl analgesics injected for treatment during postprocedure recovery. These two groups were compared to control rabbits in groups 3 and 4, which underwent inhalant anesthesia without thoracoscopy. Control group 3 also received the injection analgesic combination. During recovery, rabbit behavior was systematically assessed for evidence of pain. No behavior considered indicative of pain needing intervention was observed regardless of treatment group. Limited changes in plasma corticosterone, catecholamines, and prostaglandin E2 levels measured during recovery were difficult to associate with any treatment. Unexpectedly, significantly different mean corticosterone and catecholamines levels were detected in rabbits given the injection analgesic combination in the absence of thoracoscopic procedure, as compared to other treatment groups. The results highlight the importance of awareness that analgesic drug administration has the potential to alter homeostasis and affect interpretation of some study findings by its own guise. Correlation of the mean pain study results with plasma biochemical data supports preferential use of thoracoscopy as a refinement for limiting postprocedural pain in research models.

Peripheral nerve injuries during cardiac surgery: risk factors, diagnosis, prognosis, and prevention.

Neuropathies involving the brachial plexus, phrenic, recurrent laryngeal, and saphenous nerves, as well as the sympathetic chain are complications of cardiac surgery. The reported frequency of nerve injuries varies from 1.5% to 24% for the brachial plexus and 10% to 60",,6 for the phrenic nerve (1-5). Neuropathies of the recurrent laryngeal, lower limb (saphenous) nerves, and the sympathetic chain are less frequent.

下顎骨区域切除後に発症し救命しえた肺塞栓症の１例

We report a case of pulmonary embolism that occurred after mandibulectomy. A 59-year-old woman underwent mandibulectomy for a keratocyst arising in the left side of the mandible. After being moved for treatment on the morning of the first postoperative day, vomiting, transient uncousciousness, chest pain, and dyspnea suddenly occurred. Pulmonary embolism (PE) was diagnosed on the basis of hypoxia, overload of the right ventricle, and RI scintigraphy of pulmonary blood flow. Heparin was administered intravenously as anticoagulant therapy immediately after the episode. She successfully recorvered from PE and was discharged on the 35th postoperative day.

Anterior Limited Thoracotomy With Intrathoracic Illumination for Lung Cancer: Its Advantages Over Anteroaxillary and Posterolateral Thoracotomy

We developed anterior limited thoracotomy (ALT) with intrathoracic illumination for curative resection of lung cancer. The present study evaluated the benefits of ALT by retrospective comparison with anteroaxillary thoracotomy (AAT) and posterolateral thoracotomy (PLT). Lung cancer patients, who underwent lobectomy via ALT (n = 28), AAT (n = 28), and PLT (n = 28), were matched by gender and age. Operating time, blood loss during operation, chest tube drainage volume 24 h after surgery, chest tube drainage duration, and vital capacity (VC) and chest pain from early to late postoperative period were studied for ALT, AAT, and PLT. Early postoperative chest pain was evaluated by a visual analog scale and analgesic requirements, and chronic pain was divided into five grades. No difference was observed in operating time among ALT, AAT, and PLT. ALT has the following advantages over PLT: (1) less blood loss during surgery (p < 0.05); (2) reduced postoperative drainage volume (p < 0.05) resulting in shorter chest tube drainage (p < 0.001); (3) diminished impairment of VC for 1 week to 6 months after surgery (p < 0.01 or p < 0.001); and (4) reduced pain from 1 day and 6 months after surgery (p < 0.001). ALT also has the advantage over AAT in reduced pain 5 days (p < 0.01) and 7 days (p < 0.05) after surgery and in decreased analgesic requirements during 14 days after surgery (p < 0.05). ALT is a sufficient and minimally invasive thoracotomy alternative to PLT or AAT for curative lung cancer resection.

Coronary artery operation in patients after breast cancer therapy

Objective. The purpose of this investigation was to retrospectively study the outcome of patients undergoing coronary artery operation who were previously treated for breast cancer. Methods. Between July 1992 and December 1996, 28 patients with a history of breast cancer underwent coronary artery bypass graft operation and were randomly matched against a noncancer group of similar size (n = 36) to allow for comparison of their preoperative characteristics, operative course, and postoperative outcome. Results. The incidence of sternal wound infection was significantly higher in the cancer group than in the control group (25% versus 6%; p = 0.027). Postoperative noncardiac chest pain occurred more frequently in the cancer group than in the control group (52% versus 31%; not significant). In the study group, radiotherapy and recent myocardial infarction were the only two independent factors associated with sternal wound complications. Patients with a less than 17-year interval between the breast cancer therapy and the coronary artery operation had a higher incidence of sternal wound infection (46%) as opposed to patients with a longer time interval (7%; p = 0.028; odds ratio = 12). Sternal wound complications were more frequent in patients with a history of right-sided breast cancer (50%) compared with left-sided lesions (12.5%; p = 0.068; odds ratio = 7). Conclusions. Coronary artery operation in patients after breast cancer therapy may be associated with an increased sternal wound infection rate. To decrease this risk of infection, an approach through a right thoracotomy, minimally invasive techniques, the use of skeletonized internal mammary artery, and broad spectrum antibiotic therapy may be considered.