Research output: Contribution to journal › Article › Academic › peer-review
Outcomes of cardiac surgery after mediastinal radiation therapy: A single-center experience. / Dolmaci, Onur B.; Farag, Emile S.; Boekholdt, S. Matthijs et al.
In: Journal of cardiac surgery, Vol. 35, No. 3, 01.03.2020, p. 612-619.Research output: Contribution to journal › Article › Academic › peer-review
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TY - JOUR
T1 - Outcomes of cardiac surgery after mediastinal radiation therapy: A single-center experience
AU - Dolmaci, Onur B.
AU - Farag, Emile S.
AU - Boekholdt, S. Matthijs
AU - van Boven, Wim J. P.
AU - Kaya, Abdullah
PY - 2020/3/1
Y1 - 2020/3/1
N2 - 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.
AB - 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.
KW - cardiac surgery
KW - mediastinal radiation therapy
KW - radiation therapy
KW - valve surgery
UR - http://www.scopus.com/inward/record.url?scp=85078773204&partnerID=8YFLogxK
U2 - 10.1111/jocs.14427
DO - 10.1111/jocs.14427
M3 - Article
C2 - 31971292
VL - 35
SP - 612
EP - 619
JO - Journal of cardiac surgery
JF - Journal of cardiac surgery
SN - 0886-0440
IS - 3
ER -
ID: 10838538