Frequency of Severe Valvular Disease Caused by Mediastinal Radiation Among Patients Undergoing Valve Surgery in a Community‐Based, Regional Academic Medical Center

Abstract

Background Our goal was to define the prevalence of radiation‐induced valvular heart (RIVD) disease among patients undergoing cardiac valve surgery in a community‐based, regional academic medical center. Mediastinal radiation is a treatment modality for various hematologic and solid malignancies; however, long‐term cardiac complications, including radiation‐induced valvular heart disease, can occur years after the radiation treatments. Hypothesis Mediastinal radiation exposure is an independent risk factor for valvular heart disease often necessitating valve replacement in patients without other risk factors for valve disease. Methods Between January 1, 1998 and September 1, 2007, we retrospectively analyzed our institution's cardiac surgical database over a 10 year period and identified 189 consecutive patients ≤ 50 years of age who underwent valve surgery. Using case‐control matching, we assessed the prevalence of mediastinal radiation among these young patients with valve disease necessitating surgery and to their matched controls from all patients admitted to the hospital. Results Nine individuals (4.8%) were identified as having received previous mediastinal radiation, significantly increased from controls (p<0.0001), and 8 of whom had surgical or pathologic findings consistent with radiation damage. Compared with a matched case‐control population, individuals who had severe valve disease and underwent valve replacement had a markedly increased prevalence of prior mediastinal radiation therapy. Conclusions In conclusion, cardiologists must remain aware of the potential long term valvular complications in patients treated with mediastinal radiation. Increased surveillance for RIVD may be considered in the decades following radiation therapy.

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

“…Childhood cancer survivors have a higher than expected incidence of tricuspid regurgitation, and the explanation remains to be determined . Affected survivors are often no longer under the care of a treating cancer specialist at the time of VHD diagnosis and, strikingly, the diagnosis of cancer or history of radiation therapy is often not mentioned in the patients' current medical records . The European Association of Cardiovascular Imaging and the American Society of Echocardiography (EACVI/ASE) recommend a focused yearly history and physical examination with echocardiography in symptomatic patients .…”

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

“…U osób, które przebyły leczenie przeciwnowotworowe w dzieciństwie, stwierdza się większą od spodziewanej częstość występowania niedomykalności trójdzielnej, ale na razie nieznane jest wyjaśnienie tej obserwacji [307]. W momencie rozpoznania VHD pacjent, który przebył leczenie przeciwnowotworowe, często nie jest już pod opieką specjalisty prowadzącego leczenie onkologiczne, a o rozpoznaniu nowotworu lub przebytej radioterapii często nie ma żadnej wzmianki w bieżącej dokumentacji medycznej chorego [308]. European Association of Cardiovascular Imaging (EACVI) i American Society of Echocardiography (ASE) zalecają ukierunkowane coroczne badania podmiotowe i przedmiotowe, połączone z echokardiografią u objawowych pacjentów [95].…”

Outcomes After Transcatheter Aortic Valve Replacement in Cancer Survivors with Prior Chest Radiation Therapy: A Systematic Review and Meta-Analysis

“…Valvular heart disease occurs in approximately 81% of cancer survivors with prior chest radiation therapy (C-XRT) and a frequent initial manifestation is aortic-valve stenosis (AS) [1]. With increased longevity, a substantial portion of these patients develop symptomatic AS [2][3][4]. The mortality rate is up to 90% in a 2year natural history of patients having symptomatic AS [5,6].…”