Cardiac surgery after mediastinal radiation: Extent of exposure influences outcome

Chang, Albert S.; Smedira, Nicholas G.; Chang, Catherine; Benavides, Monica M.; Myhre, Ulf; Feng, Jingyuan; Blackstone, Eugene H.; Lytle, Bruce W.

doi:10.1016/j.jtcvs.2006.09.041

Cited by 98 publications

(83 citation statements)

References 35 publications

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“…Compared with a healthy population of a similar age not undergoing cardiac surgery (86% survival at 10 years), the survival of radiation heart disease patients was far worse. 6 During follow-up, there was a 72% survival rate in the comparison group compared with 45% survival in the radiation group. This finding was consistent across various subgroups, including those in which the expected mortality is lower (eg, younger age and low perioperative risk).…”

Section: Discussionmentioning

confidence: 94%

“…These patients have multiple cardiac lesions and have comorbidities such as pulmonary or vascular disease related to radiation that may affect their short-and long-term outcomes. Although there are multiple previous small reports, 3,4,6,[13][14][15][16] the absence of data on the long-term outcomes of this population, particularly compared with a standard cardiothoracic surgical population, makes decision making especially difficult. We sought to measure long-term survival in patients with radiation heart disease who underwent cardiothoracic surgery, to compare those patients with a matched population undergoing similar surgical procedures during the same time frame, and to identify potential predictors of long-term survival.…”

Section: Clinical Perspective On P 1484mentioning

confidence: 99%

“…Another study demonstrated that prior history of extensive radiation (versus tangential exposure) was associated with worse survival after cardiac surgery. 6 To the best of our knowledge, ours is the largest study to assess longterm survival in this population undergoing complex cardiac surgery and to compare them with a well-matched comparison population.Our findings suggest that surgical intervention should be applied cautiously to patients who have previously had significant thoracic radiation because the realized survival does not necessarily match what would be expected in a nonradiated population. Survival is even worse in those who have already undergone an open heart surgical procedure.…”

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confidence: 99%

“…[1][2][3][4][5][6][7] The long-term cardiac effects of radiation are heterogeneous and include coronary artery disease (CAD; especially ostial/ proximal), valvular disease, pericardial disease, myocardial disease with systolic and especially diastolic dysfunction, and conduction disease. [8][9][10][11][12] The lungs, great vessels, and carotid arteries may also be involved.…”

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confidence: 99%

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Long-Term Survival of Patients With Radiation Heart Disease Undergoing Cardiac Surgery

et al. 2013

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Background-Thoracic radiation results in radiation-associated heart disease (RAHD), often requiring cardiothoracic surgery (CTS). We sought to measure long-term survival in RAHD patients undergoing CTS, to compare them with a matched control population undergoing similar surgical procedures, and to identify potential predictors of long-term survival. Methods and Results-In this retrospective observational cohort study of patients undergoing CTS, matched on the basis of age, sex, and type/time of CTS, 173 RAHD patients (75% women; age, 63±14 years) and 305 comparison patients (74% women; age, 63±4 years) were included. The vast majority of RAHD patients had prior breast cancer (53%) and Hodgkin lymphoma (27%), and the mean time from radiation was 18±12 years. Clinical and surgical parameters were recorded. The preoperative EuroSCORE and all-cause mortality were recorded. The mean EuroSCOREs were similar in the RAHD and comparison groups (7.8±3 versus 7.4±3, respectively; P=0.1). Proximal coronary artery disease was higher in patients with RAHD versus the comparison patients (45% versus 38%; P=0.09), whereas redo CTS was lower in the RACD versus the comparison group (20% versus 29%; P=0.02). About two thirds of patients in either group had combination surgical procedures. During a mean follow-up of 7.6±3 years, a significantly higher proportion of patients died in the RAHD group than in the comparison group (55% versus 28%; P<0.001). On multivariable Cox proportional hazard analysis, RAHD (2.47; 95% confidence interval, 1.82-3.36), increasing EuroSCORE (1.22; 95% confidence interval, 1.16-1.29), and lack of β-blockers (0.66; 95% confidence interval, 0.47-0.93) were associated with increased mortality (all P<0.01). Conclusions-In patients undergoing CTS, RAHD portends increased long-term mortality. Alternative treatment strategies may be required in RAHD to improve long-term survival. (Circulation. 2013;127:1476-1484.) Key Words: heart disease ◼ radiation ◼ surgery ◼ survival © 2013 American Heart Association, Inc. history of a documented malignancy requiring chest irradiation who subsequently developed coronary/valvular disease significant enough to require cardiothoracic surgery (radiation heart disease group). The diagnosis of radiation heart disease was made after a thorough clinical and echocardiographic evaluation by experienced cardiologists. In this group, type of prior malignancy and area of radiation were ascertained. When available, the year of the last radiation dose was recorded. All patients were cleared by oncology for a cardiac surgical procedure. The second group consisted of 305 patients without a history of malignancy or chest irradiation (comparison group) who were matched with group 1 for type and time of cardiothoracic surgery, age, and sex (in that order). In the vast majority of cases, we were able to achieve a 1:2 match of radiation to comparison group. In 41 instances, there was only a 1:1 match. Clinical DataData were assembled after individual analysis of electronic medical records after...

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Section: Discussionmentioning

confidence: 94%

Section: Clinical Perspective On P 1484mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Long-Term Survival of Patients With Radiation Heart Disease Undergoing Cardiac Surgery

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“…19 Early stripping of the pericardium in planned cardiac surgery-although still challenging-might improve cardiac physiologic conditions postoperatively. 25,27 More data on the long-term management outcomes of radiation-induced CP would clarify the therapeutic options. Detecting pericardial constriction early might enable a response to medical therapy before chronic fibrosis develops and high-risk surgery becomes the only option.…”

Section: Discussionmentioning

confidence: 99%

Constrictive Pericarditis 5 Months after Radiation Therapy in a 62-Year-Old Woman with Esophageal Cancer

Yeneneh¹,

Allen²,

Panse³

et al. 2017

Texas Heart Institute Journal

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Plaster pipes and crystalized graphite: Open transventricular transcatheter aortic valve replacement for failed mechanical aortic valve prostheses in the porcelain aorta

Yong

Camuglia

Cox

et al. 2021

Cathet Cardio Intervent

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Patients with a true porcelain aorta and a failed mechanical aortic valve prosthesis have limited treatment options. Using a hybrid of an open trans-ventricular approach with peripheral cardiopulmonary bypass and integration of transcatheter techniques this challenge can be overcome. Trans-ventricular mechanical valve extraction (with transcatheter endovascular occlusion and cardioplegia) followed by direct ante-grade transcatheter heart valve implantation offers a potential solution to this conundrum.The procedure described is a novel technique that allows for the effective treatment of patients with failed mechanical surgical aortic valve prostheses in the setting of an inoperable porcelain aorta. In addition, a collaborative integrated multi-disciplinary heart team environment is required for the management of these complex patients.

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Cardiac surgery after mediastinal radiation: Extent of exposure influences outcome

Cited by 98 publications

References 35 publications

Long-Term Survival of Patients With Radiation Heart Disease Undergoing Cardiac Surgery

Long-Term Survival of Patients With Radiation Heart Disease Undergoing Cardiac Surgery

Constrictive Pericarditis 5 Months after Radiation Therapy in a 62-Year-Old Woman with Esophageal Cancer

Plaster pipes and crystalized graphite: Open transventricular transcatheter aortic valve replacement for failed mechanical aortic valve prostheses in the porcelain aorta

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