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Cardiac Surgery after Mediastinal Radiation: Impact of Extent of Radiation Exposure on Outcomes
A. S. Chang, J. Feng, E. H. Blackstone, B. W. Lytle, C. L. Chang, N. G. Smedira. Cleveland Clinic, Cleveland, OH,
BACKGROUND: Mediastinal radiation for thoracic malignancies utilizes multiple treatment fields and doses. We investigated whether extensive exposure is associated with hospital complications and worse outcomes after cardiac surgery.
METHODS: Between January 2000 and December 2004, 230 patients underwent cardiac surgery after mediastinal radiation. Three levels of exposure were defined: Group 1: extensive and direct (Hodgkin, thymoma and testicular) n = 70; Group 2: variable (lung,lymphoma,esophageal) n=33; Group 3: tangential (breast) n=125. Social Security Death Index, cardiovascular database and follow-up survey were utilized. Mean follow up was 2.2+/-1.4 years.
RESULTS: Group 1 patients were the youngest (51 vs 64 vs 72 years), with balanced genders (% female: 47 vs 33 vs 100), more aortic regurgitation > mild (79% vs 54 vs 50), more left main stenosis >70% ( 21% vs 10 vs 8) and worse pulmonary function (% predicted FEV1 57 vs 54 vs 67; % predicted FVC 56 vs 63 vs 66). Group 1 had more aortic valve repairs (7 % vs 0 vs 1); other procedures were similar. Complications are presented in the table and survival figure.
CONCLUSIONS: Despite their younger age, extensive direct radiation therapy patients had worse cardiac and pulmonary injury, more complications and diminished survival.
Complications (%)| Complication | Group 1 | Group 2 | Group 3 | P value | | Reop for bleeding | 6 | 9 | 7 | 0.8 | | CVA | 6 | 0 | 1 | 0.06 | | MI | 0 | 3 | 0 | 0.1 | | Renal Failure | 9 | 15 | 3 | 0.03 | | Respiratory Insufficiency | 24 | 21 | 10 | 0.02 | | Sepsis | 13 | 15 | 8 | 0.4 | | Hospital Death | 13 | 9 | 2 | 0.01 | 
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