PMID- 11426762
OWN - NLM
STAT- MEDLINE
DCOM- 20010712
LR  - 20190628
IS  - 0003-4975 (Print)
IS  - 0003-4975 (Linking)
VI  - 71
IP  - 6
DP  - 2001 Jun
TI  - Valvular heart operation in patients with previous mediastinal radiation therapy.
PG  - 1880-4
AB  - BACKGROUND: The outcome of valvular heart operations in patients with previous 
      mediastinal radiation therapy was studied. METHODS: This is a single center 
      retrospective study of 60 patients (37 females, 23 males) with a mean age of 62 
      +/- 15 years (28 to 88 years old) operated on from January 1976 to December 1998. 
      Valvular heart operations performed included aortic valve replacements (n = 26), 
      mitral valve procedures (n = 16), tricuspid valve procedures (n = 6), and 
      multiple valve procedures (n = 12). A total of 264 clinical, hemodynamic, 
      electrocardiographic and echocardiographic variables were analyzed. RESULTS: 
      Total follow-up was 199 patient-years with a mean of 3.3 +/- 3.1 years and a 
      range of 0 to 12.4 years old. Early mortality was 7 patients (12%). Early 
      mortality in patients with constrictive pericarditis was 40% (4 of 10) compared 
      with 6% (3 of 50) in patients without constrictive pericarditis. By univariate 
      analysis, early mortality was associated with constrictive pericarditis (p = 
      0.011), reduced preoperative ejection fraction (p = 0.015), and longer 
      cardiopulmonary bypass times (p = 0.037). A total of 14 patients (23%) required 
      permanent pacemaker placement before (n = 7), during (n = 1), or early (n = 6) 
      after valvular heart operations. There were 19 late deaths (malignancies, 7; 
      heart failures, 5; other cardiac, 4; and other noncardiac, 3). Overall survival 
      and freedom from late cardiac death and cardiac reoperation at 5 years for 
      hospital survivors were 66% +/- 8%, 82% +/- 7%, and 93% +/- 4%, respectively. By 
      univariate analysis, late cardiac death was associated with low ejection fraction 
      (p = 0.002), New York Heart Association (NYHA) functional class IV (p = 0.004), 
      preoperative congestive heart failure (p = 0.02), and preoperative atrial 
      fibrillation (p = 0.038). Eighty-five percent of the discharged patients were in 
      NYHA functional class I or II at follow-up. CONCLUSIONS: Early results of valve 
      replacement after mediastinal radiation therapy were good except in the presence 
      of constrictive pericarditis. Long-term outcome was limited by malignancy and 
      heart failure. Early surgical intervention is recommended before the development 
      of risk factors for late death, namely, severe symptoms, left ventricular 
      dysfunction, and atrial fibrillation.
FAU - Handa, N
AU  - Handa N
AD  - Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, 
      Minnesota, USA.
FAU - McGregor, C G
AU  - McGregor CG
FAU - Danielson, G K
AU  - Danielson GK
FAU - Daly, R C
AU  - Daly RC
FAU - Dearani, J A
AU  - Dearani JA
FAU - Mullany, C J
AU  - Mullany CJ
FAU - Orszulak, T A
AU  - Orszulak TA
FAU - Schaff, H V
AU  - Schaff HV
FAU - Zehr, K J
AU  - Zehr KJ
FAU - Anderson, B J
AU  - Anderson BJ
FAU - Schomberg, P J
AU  - Schomberg PJ
FAU - Puga, F J
AU  - Puga FJ
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cause of Death
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Diseases/mortality/*surgery
MH  - Heart Valves/*radiation effects/surgery
MH  - Humans
MH  - Male
MH  - Mediastinal Neoplasms/*radiotherapy
MH  - Middle Aged
MH  - Radiation Injuries/mortality/*surgery
MH  - Reoperation
MH  - Retrospective Studies
MH  - Survival Rate
EDAT- 2001/06/28 10:00
MHDA- 2001/07/13 10:01
CRDT- 2001/06/28 10:00
PHST- 2001/06/28 10:00 [pubmed]
PHST- 2001/07/13 10:01 [medline]
PHST- 2001/06/28 10:00 [entrez]
AID - S0003497501025887 [pii]
AID - 10.1016/s0003-4975(01)02588-7 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2001 Jun;71(6):1880-4. doi: 10.1016/s0003-4975(01)02588-7.