Outcomes of Surgery in Cardiac Angiosarcoma

Rahouma, Mohamed; Tafuni, Alessandro; Dabsha, Anas; Baudo, Massimo; Khairallah, Sherif; Corradi, Domenico; Gaudino, Mario; Lorusso, Roberto

doi:10.1016/j.jaccao.2022.10.011

Cited by 4 publications

(12 citation statements)

References 6 publications

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“…The first is hypercoagulability. [3,4] Flap loss most often occurs because of thrombosis of the microvascular pedicle secondary to technical factors, such as intimal damage, vessel kinking, and technical errors regarding the anastomosis. However, despite appropriate surgical techniques and follow-up, flap failure can occur due to systemic influences.…”

Section: Discussionmentioning

confidence: 99%

“…There is considerable evidence that thrombosis is a common complication of malignancy and the second most frequent cause of death in cancer patients. [3] Prothrombotic factors in cancer include procoagulant/fibrinolytic substances and inflammatory cytokines secreted by the tumor and the physical interaction between tumor cells and blood (monocytes, platelets, neutrophils) or vascular cells. Other mechanisms of thrombus promotion in malignancy include nonspecific factors, such as generation of acute-phase reactants, necrosis (inflammation), abnormal protein metabolism (paraproteinemia), and hemodynamic compromise (stasis).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with advanced cancer often have comorbidities that can lengthen the operation time. [3] It is therefore crucial to meticulously plan and optimize the surgical approach to minimize the operative time. Close collaboration with a multidisciplinary team, including medical oncologists and anesthesiologists, is essential to ensure that the patient's general condition is suitable for the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The cytotoxic properties of these agents affect cell proliferation, migration, and collagen synthesis, all of which play crucial roles in the timely and effective healing of wounds. [2] In addition, cancer patients have hypercoagulability, [3,4] which affects flap stabilization. Free-flap procedures require adequate blood flow.…”

Section: Introductionmentioning

confidence: 99%

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Free flap reconstruction of scalp in a case of advanced lung cancer with brain metastasis: A case report

Lee,

Lim,

et al. 2023

Medicine

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Rationale: Reconstruction of wound complications in patients with advanced cancer with distant metastases is challenging for plastic surgeons. This may be due to the cancer patients’ hypercoagulability and potential intolerance to general anesthesia. This article aimed to discuss the risk of free-flap reconstruction in such cases. Patient concerns: The patient was a 58-year-old female with advanced non-small cell lung cancer and brain metastasis. The patient underwent brain radiotherapy and chemotherapy through the Ommaya Reservoir. Diagnoses: A year ago, she underwent several local flap closures for recurrent wound healing failure due to wound complications, including infection, wound dehiscence, and subsequent device removal. Interventions: A radial forearm free flap was created under general anesthesia. The patient was discharged in the third postoperative week since the flap remained stable. Outcomes: At follow-up a month thereafter, the patient exhibited signs of recovery without any complications even while continuing her chemotherapeutic regimen. Lessons: Free flap placement is not an absolute contraindication in cancer patients with distant metastases. Nevertheless, it is associated with clinical challenges and operator hesitancy. This is a case of a successful free flap in a cancer patient with hypercoagulability and suspected floating tumor cells. Postoperative management, in this case, is appropriate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Free flap reconstruction of scalp in a case of advanced lung cancer with brain metastasis: A case report

Lee,

Lim,

et al. 2023

Medicine

View full text Add to dashboard Cite

show abstract

“…Recently a single-center clinical series of 17 Ca-NBTE cases was published 13 as well as a large systemic review and meta-analysis containing cases published as far back as 1946. 14 We present a results of retrospective cohort study including 115 patients with Ca-NBTE from a single institution encompassing referral centers, and regional sites of different geographic areas analyzing malignancy type and stage, heart valve involvement, embolic complications, treatment, and outcomes.…”

mentioning

confidence: 99%

Cancer‐associated non‐bacterial thrombotic endocarditis—Clinical series from a single institution

Patrzalek,

Wysokinski,

Kurmann

et al. 2024

American J Hematol

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Premortem clinical presentation of cancer‐associated non‐bacterial thrombotic endocarditis (Ca‐NBTE), therapy, and the clinal course is limited to case reports and small clinical series. An electronic search of Mayo Clinic records (03/31/2002–06/30/2022) with a subsequent manual review was performed to identify adult patients with echocardiographically detected NBTE and active malignancy, excluding those with infectious endocarditis or lupus anticoagulant/antiphospholipid antibodies. In this retrospective cohort study, we analyzed 115 Ca‐NBTE patients (mean age 63.2 ± 9.7 years, 66.1% female) involving 71 (61.7%) mitral, 58 (50.4%) aortic, 8 (6.9%) tricuspid, and 1 (0.9%) pulmonary valve. The most common cancer was lung (n = 45 cases (39.1%), followed by pancreatic (n = 19, 16.5%), gynecological (17, 14.8%), gastrointestinal (n = 10, 8.7%), and 10 (8.7%) with hematologic malignancy; 6 patients had two active cancers. Embolic complications at presentation were frequent: 94 (81.7%) brain, 11 splenic, 10 renal, 6 coronary, and 4 to the extremities. Of 104 anticoagulated patients, 60 received low molecular weight heparin, 17 unfractionated heparin, 16 apixaban, 8 warfarin, and 3 rivaroxaban. There were 18 arterial thromboembolisms; the Kaplan–Meier estimates of the incidence at 2 years were consistent with a rate of 15.9% [95% Confidence Interval (CI) 9.9–23.3], including 14 strokes (12.4%, 95%CI, 7.1–19.2), and 8 other arterial emboli (10.5%, 95%CI, 4.7–18.9); there were 10 venous thromboembolisms (8.9%, 95%CI, 4.5–15.0). Fourteen major bleedings occurred (12.8%, 95%CI, 7.3–19.9) and 94 patients died during follow‐up (77.9%, 95%CI, 71.1–85.8). Ca‐NBTE predominantly affected women with lung adenocarcinoma or digestive tract cancers and manifested by stroke with high mortality and frequent embolic and bleeding complications during anticoagulation therapy.

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Surgically Resected Cardiac Angiosarcoma: Survival Analysis from the National Cancer Database

Rahouma,

Baudo,

Khairallah

et al. 2023

JCM

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Angiosarcoma is a rare type of soft-tissue sarcoma arising from endothelial cells. It is considered ‘high-grade’ by definition, reflecting its aggressive behavior. We sought to investigate the role of surgery in cardiac angiosarcoma, identify late mortality predictors, and identify interactions with other modalities in its treatment using a national dataset. The 2004–2017 National Cancer Database was reviewed for patients with primary cardiac angiosarcoma. Late mortality predictors were evaluated with Kaplan–Meier curves and Cox regression analysis. Surgery in primary cardiac angiosarcoma was performed in 130 patients (median age 50.5 years; female sex 36.9%). The median follow up was 72.02 months, with a median overall survival (OS) of 14.32 months. In patients treated with surgery in combination with other modalities compared with those treated with surgery alone, median OSs were 17.28 and 2.88 months, respectively (log-rank = 0.018). Older patients (age > 57 years) experienced lower OS compared to those with an age < 57 (log-rank = 0.012). This may be partially explained by the difference in treatment strategies among age groups: those with increasing age, less surgery (p = 0.037), and less chemotherapy (p < 0.001) were chosen. With multivariable Cox regression analysis, age and race other than white or black were identified to be significant independent predictors of late mortality. Cardiac angiosarcoma has poor overall survival, and our findings should further encourage the use of surgery in combination with other therapeutic modalities in treating such an aggressive disease whenever possible.

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Outcomes of Surgery in Cardiac Angiosarcoma

Cited by 4 publications

References 6 publications

Free flap reconstruction of scalp in a case of advanced lung cancer with brain metastasis: A case report

Free flap reconstruction of scalp in a case of advanced lung cancer with brain metastasis: A case report

Cancer‐associated non‐bacterial thrombotic endocarditis—Clinical series from a single institution

Surgically Resected Cardiac Angiosarcoma: Survival Analysis from the National Cancer Database

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