Heart diseases following mediastinal irradiation: surgical management

Reber, Delawer; De, Birnbaum; Tollenaere, P

doi:10.1016/s1010-7940(05)80145-9

Cited by 39 publications

(23 citation statements)

References 19 publications

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“…Previous studies of long-term outcomes (with or without cardiac surgery) in radiation heart disease patients are limited but demonstrate increased morbidity and mortality. [1][2][3][4]6,[13][14][15][16] Previous surgical reports have demonstrated various predictors of short-term (constrictive pericarditis, reduced preoperative ejection fraction, longer cardiopulmonary bypass times) and long-term outcomes (radiation dose, duration of radiation). [2][3][4] However, these studies had significantly smaller sample sizes and patients with complex surgeries (eg, CABG plus valve procedures) were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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: 99%

Section: Clinical Perspective On P 1484mentioning

confidence: 99%

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

et al. 2013

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“…Risk factors for radiation CAD include anterior exposure without shielding, total radiation dose of greater than 35 Gy, young age at time of exposure, and preexisting heart disease [5,6]. Because of the radiation fields involved, ostial coronary artery stenoses are seen of all of the three major coronary arteries, but left main coronary artery stenosis has been commonly seen in angiographic studies of small groups of studied patients [7][8][9][10] and has been associated with more extensive radiation therapy in disease states such as HL, thymoma, and testicular cancer [11].…”

Section: Discussionmentioning

confidence: 99%

Radiation coronary arteritis refractory to surgical and percutaneous revascularization culminating in orthotopic heart transplantation

Cheng

Lee

Seki

et al. 2013

Cardiovascular Pathology

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Radiation coronary arteritis refractory to surgical and percutaneous revascularization culminating in orthotopic heart transplantation. Background: Hodgkin's lymphoma (HL) comprises of 4% of malignancies diagnosed in children from birth to 14 years of age. While overall survival rates have increased, HL survivors can be at risk of late cardiovascular complications from radiotherapy. HL survivors with a history of mediastinal RT have been found to have an increased incidence of myocardial infarction, angina, congestive heart failure, and valvular disorders compared to the general population. Methods: A 33 year old female with a history of HL status post chemotherapy and mediastinal radiation 11 years ago became symptomatic with multivessel coronary artery disease with aggressive progression of her disease despite coronary bypass graft surgery, patch angioplasty of the left main coronary artery (LMCA) with an extracellular bioscaffold, and repeated percutaneous coronary intervention of the LMCA. She eventually underwent orthotopic heart transplant and did well postoperatively. Results: Histopathological analysis of the explanted heart revealed a variety of sequelae of radiation arteritis, including thrombosis of both native vessels and arterial grafts, intimal hyperplasia and involvement of the bioscaffold in the left main coronary vasculature. The bioscaffold did not contribute significantly to the stenosis within the LMCA. Conclusion: Our case demonstrates an unusual indication for OHT due to severe refractory radiation induced CAD, as well the wide spectrum of the histopathologic manifestations of radiation induced arteritis.

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“…It also well known that radiation can cause cardiac disease including pericarditis, valvular thickening and calcification with insufficiency, myocardial fibrosis with congestive heart failure or conduction abnormalities such as left bundle branch block or complete heart block [2]. Accelerated atherosclerosis has also been described due to intimal proliferation of fibrous tissue [3].…”

Section: Discussionmentioning

confidence: 99%