Long-term outcomes of mitral valve surgery after mediastinal radiation therapy (MRT)
are not well characterized. We analyzed long-term survival in patients who underwent
mitral valve repair or replacement after MRT. From 2001 to 2018, 148 patients underwent
mitral valve surgery at our institution after MRT for cancer. The association between
surgery group and survival was assessed using Cox proportional hazards modeling, with
propensity score adjustment to control for clinical and operative differences between
groups. Mitral valve was repaired in 48 (32.4%) and replaced in 100 (67.6%) patients.
The groups (repair vs replacement) were similar in age (62.0 vs 57.1 years, p = 0.10),
gender (female n = 38, 79.2% vs n = 65, 65%, p = 0.08), chronic lung disease (n = 12,
25.0% vs n = 37, 37.0%, p = 0.19), congestive heart failure (n = 13, 27.1% vs n = 38,
38.4%, p = 0.20), but differed in atrial fibrillation (n = 17, 35.4% vs n = 13, 13.0%,
p = 0.002), first cardiovascular surgery (n = 34, 70.8% vs n = 47, 47.0%, p = 0.006),
and time since MRT (median 12, 7–27 years, vs 30, 19–37 years, p < 0.001). Long term
survival was no different between groups in the unadjusted (p = 0.835) and propensity-adjusted
(p = 0.645) analysis, and inferior to the expected survival of an age- and sex-matched
population. Mediastinal irradiation negatively impacts survival in patients who undergo
mitral valve surgery. The traditional advantage of mitral valve repair over replacement
on long-term survival was not seen in patients with radiation associated mitral valve
disease.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
CABG (coronary artery bypass grafting), CHF (congestive heart failure), MR (mitral regurgitation), MRT (mediastinal radiation therapy), MS (mitral stenosis), MVR (mitral valve replacement), MVr (mitral valve repair), RACD (radiation associated cardiac disease)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 07, 2021
Footnotes
Funding: None.
Conflicts of Interest: None.
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© 2021 Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Commentary: Is There a Second Chance to Treat Mitral Disease After Irradiation?Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 4
- Commentary: Providing the Same Treatment will not Lead to Different OutcomesSeminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 4
- PreviewRadiation therapy (RT) is the mainstem treatment of different types of malignant chest wall and mediastinal tumors, providing improved survival. However, RT-associated cardiac diseases may occur, leading to complex clinical presentations, requiring unique management strategies, and leading to increased morbidity and mortality. It may take years, or even decades after RT, for the development of first symptoms. Valvular abnormalities, resulting from RT, range from 7% to 39% at 10 years, and 12% to 60% at 20 years.
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