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Long-Term Survival of Patients With Radiation Heart Disease Undergoing Cardiac Surgery: A Cohort Study
Study Questions:
What is the long-term survival in patients with radiation-associated heart disease (RAHD) undergoing cardiothoracic surgery (CTS), compared to a matched control population undergoing similar surgical procedures?
Methods:
This was a retrospective observational cohort study of 478 consecutive patients who underwent CTS at a tertiary referral center between 2000 and 2003. The study population consisted of two groups: one with RAHD (n = 173) and a comparison population (n = 305). Patients were matched on basis of age, sex, and type and time of CTS. The majority of RAHD patients had prior breast cancer (53%) and Hodgkin lymphoma (27%), and the mean time from radiation was 18 ± 12 years. Over one third of patients in either group had isolated single-valve or coronary bypass procedures.
Results:
The mean EuroSCOREs were similar in the RAHD and comparison groups (7.8 ± 3 vs. 7.4 ± 3, respectively, p = 0.1). During a mean follow-up of 7.6 ± 3 years, there were 179 deaths (37%) in the study population. A significantly higher proportion of patients in the RAHD group died versus the comparison group (55% vs. 28%; hazard ratio, 2.54; 95% confidence interval, 1.89-3.43; p < 0.001). On multivariable Cox proportional hazard analysis in the entire population, RAHD was a potent predictor of mortality (hazard ratio, 2.47; 95% confidence interval, 1.82-3.36; p < 0.001).
Conclusions:
When compared to a matched comparison population, patients with RAHD undergoing CTS have a worse long-term survival.
Perspective:
This large observational study offers insight into the survival of patients with RAHD undergoing CTS by juxtaposing them to a well-matched comparison population. The findings are meaningful and highlight the potential poor long-term results following CTS among those with RAHD. As the authors have suggested, surgical intervention should be undertaken cautiously in this population, and alternative strategies (e.g., transaortic technology for those with aortic stenosis and who are suitable candidates) should be considered. Future studies should better characterize this population and the feasibility of such nonsurgical strategies.
Keywords: Heart Diseases, Incidence, Follow-Up Studies, Breast Neoplasms, Risk Factors, Hodgkin Disease, Coronary Artery Bypass, Cardiac Surgical Procedures, Angioplasty, Balloon, Coronary, Radiation Injuries
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