Key result
Cardiac surgery after mediastinal radiotherapy resulted in a 30-day mortality of 6.8% and in-hospital mortality of 10.2%, exceeding the 3.4% predicted by the Euroscore II.
Why the study?
Mediastinal radiation therapy for thoracic malignancies can cause cardiovascular injuries requiring surgery, but perioperative outcomes and predictors of mortality in these patients needed identification.
Cohort (n=59)
No
Absolute Event Rate: 6.8% vs 3.4%
Cardiac surgery in patients with prior mediastinal radiotherapy is associated with higher short- and long-term mortality than predicted by standard risk scores like Euroscore II.
Observed mortality exceeds Euroscore II predictions after mediastinal radiotherapy; leaves open whether radiotherapy-specific models improve risk stratification.
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.
No takes yet. Share an insight, caveat, or question.
Dolmaci et al. (2020) conducted a cohort in Prior mediastinal radiation therapy requiring cardiac surgery (n=59). Cardiac surgery vs. Euroscore II predicted risk was evaluated on 30-day mortality. Cardiac surgery after mediastinal radiotherapy resulted in a 30-day mortality of 6.8% and in-hospital mortality of 10.2%, exceeding the 3.4% predicted by the Euroscore II.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: