Outcomes of cardiac surgery after mediastinal radiation therapy: A single‐center experience

Abstract

Background Mediastinal radiation therapy (MRT) is a widely used therapy for thoracic malignancies. This therapy has the potential to cause cardiovascular injuries, which may require surgery. The primary aim of this study is to identify the perioperative outcomes of cardiac surgery in patients with a history of MRT. Second, potential predictors of mortality and adverse events were identified. Methods A retrospective study was conducted among 59 patients with prior MRT who underwent cardiac surgery between December 2009 and March 2015. Included surgeries consisted of procedures through median‐ and ministernotomy. Baseline, perioperative, and follow‐up data were obtained and analyzed. Results The majority of patients had a history of breast cancer (n = 43), followed by Hodgkin lymphoma (n = 10) and non‐Hodgkin lymphoma (n = 3). Preoperative estimated mortality with the Euroscore II was 3.4%. Overall 30‐day mortality was 6.8% (n = 4), with a total in‐hospital mortality of 10.2% (n = 6). Postoperatively, nine rethoracotomies (15.3%) had to be performed. During a mean follow‐up of 53 months, an additional 10 patients (16.9%) died, of which 60% (n = 6) as a result of cancer‐related events. Cox proportional modeling showed no differences in mortality between primary malignancies (P > .05). Conclusion This study shows that cardiac surgery after mediastinal radiotherapy is associated with increased short‐ and long‐term mortality when compared to preoperative mortality risks predicted by the Euroscore II. Surgery‐related events caused all short‐term mortality cases, while malignancy‐related events were the main cause of death during the follow‐up. Mortality was higher in patients with a previous stroke and a lower estimated glomerular filtration rate.

Radiotherapy-Induced Heart Disease: What Can We Evaluate?

“…The simultaneous involvement of diverse heart structures, the comorbidities, and the limitations for invasive cardiovascular treatment reinforce the need for a rigorous control of cardiovascular risk factors, strategies of cardioprotection during RT, and the use of multimodality imaging (Figure 2) to reach an early diagnosis aimed at improving clinical results. 1,2,4,14…”

Look, Simulate, Treat

“…RT-induced valvulopathies are associated with cardiopulmonary disorders such as mediastinal and pulmonary fibrosis, constrictive pericarditis, coronary disease, porcelain aorta, and extensive valve calcification which incurs an elevated surgical risk that is not predicted by standard surgical risk scoring systems ( 7 ). Likewise, the effects of RT on valves are usually extensive, and adjacent structures, such as subvalvular apparatus, annulus, and especially the aortomitral curtain ( 7 ), are commonly involved, and higher thickening is a robust predictor of mortality ( 8 ). Mitral and aortic valves are usually affected simultaneously, and even if there is only moderate disease in one of them, it is recommended that both valves be replaced because there is a rapid progression and the very high risk of a potential reoperation.…”