Cardiac Surgery in Patients after Extensive Radiotherapy on the Mediastinum

Renat Muratovich Muratov , Svetlana Ivanovna Babenko , Natalya Nikolaevna Soboleva , Ekaterina Aleksandrovna Andrianova

Scientific center of cardiovascular surgery named after A. N. After Bakulev, Moskva, Russia

Date, time and location: 2018.05.27 08:30, Congress Hall, 2F–C

Abstract

Radiation exposure to the thorax is associated with substantial risk for the subsequent development of cardiovascular disease. Associated cardiovascular injuries include pericardial disease, coronary artery disease, valvular disease, conduction disease, cardiomyopathy, and medium and large vessel vasculopathy. The goal of this study is to describe the postoperative course and complications after valve cardiac surgery in patients previously irradiated.

Methods. From January 2004 years until December 2017 years 46 patients underwent cardiac surgery in department urgent surgery A.N. Bakoulev Scientific Center for Cardiovascular Surgery after previous irradiation on the mediastinum. Data on radiotherapy were collected retrospectively. Patients were treated with radiotherapy at an average age of 4-40 years (range 25 years). The interval between radiation therapy and cardiac surgery was approximately years (range 26 years). 37 (80%) patients were female, 9 (20%) were male. Mean age was 56,0 + 12,4 years (range 35-81). Aortic stenosis is the most frequent valvular pathology. The coronary lesions are located predominantly in the ostial or proximal regions of the epicardial vessels.

Results. Isolated aortic replacement was performed in 14(30%) of patients; the rest were combination surgeries. Pleural and pericardial effusion 11(24%) were the most common postoperative complications. One patient had to be reoperated for bleeding. A total of 3 patients (6,5%) required permanent pacemaker placement Overall hospital mortality was 5 (11% ). No hospital mortality after radiotherapy on the mediastinum at mastectomy. The median postoperative intensive care unit (ICU) stay was 2,2 days.

Conclusion. The early postoperative outcome of cardiac surgery in this population is reasonably good. The long-term results may prove to be disappointing, but the cohort is small. With increasingly prolonged survival following mediastinal irradiation, we believe that long term follow up in patients who receive mediastinal irradiation is indicated.