Abruzzo Annie R, McGurk Siobhan, Tolis George, Aranki Sary, Sabe Ashraf, Cunningham Mark J, Nohria Anju, Itoh Akinobu
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
JTCVS Open. 2024 Oct 29;23:134-146. doi: 10.1016/j.xjon.2024.10.024. eCollection 2025 Feb.
Patients with cancer who receive radiation therapy to the thorax often develop radiation-induced heart disease (RIHD) decades later. Previous chest radiation is associated with elevated perioperative risk of complications and mortality after cardiac surgery. Whether the type of valve (mechanical vs bioprosthetic) used affects outcomes in patients with RIHD is unknown.
This retrospective review analyzed the characteristics and postoperative outcomes of patients with a previous history of chest radiation for Hodgkin or non-Hodgkin lymphoma who underwent surgical valve replacement at a single institution between 2000 and 2021. Both 30-day perioperative outcomes and long-term survival were assessed.
Patients who received mechanical valve tended to be younger, have more valves replaced, and have undergone previous coronary artery bypass grafting than bioprosthetic valve recipients. Valve type alone did not alter perioperative complications or overall survival. Median survival was 11.0 years in mechanical and 10.9 years in bioprosthetic valve patients ( = .930). Twelve patients underwent valve reinterventions (6 mechanical, 6 bioprosthetic), and 3 underwent transplant. Single-valve (aortic valve or mitral valve) recipients fared better with median survival of 13.3 years compared with 6.2 years in those who underwent combined aortic valve replacement plus mitral valve replacement ( < .0001).
Patients with RIHD who undergo surgical valve replacement have similarly suboptimal short- and long-term outcomes regardless of mechanical versus bioprosthetic valve type. Those who required combined aortic and mitral valve replacement had especially high 10-year overall mortality. Further investigation in a larger dataset including transcatheter approaches is warranted.
接受胸部放疗的癌症患者往往在数十年后会发生放射性心脏病（RIHD）。既往胸部放疗与心脏手术后围手术期并发症风险和死亡率升高相关。使用的瓣膜类型（机械瓣膜与生物瓣膜）是否会影响RIHD患者的预后尚不清楚。
本回顾性研究分析了2000年至2021年期间在单一机构接受手术瓣膜置换的既往有霍奇金或非霍奇金淋巴瘤胸部放疗史患者的特征和术后结局。评估了30天围手术期结局和长期生存率。
与生物瓣膜置换受者相比，接受机械瓣膜置换的患者往往更年轻，置换的瓣膜更多，并且既往接受过冠状动脉旁路移植术。仅瓣膜类型并未改变围手术期并发症或总体生存率。机械瓣膜置换患者的中位生存期为11.0年，生物瓣膜置换患者为10.9年（P = 0.930）。12例患者接受了瓣膜再次干预（6例机械瓣膜，6例生物瓣膜），3例接受了移植。单瓣膜（主动脉瓣或二尖瓣）置换受者的中位生存期为13.3年，优于接受主动脉瓣置换加二尖瓣置换患者的6.2年（P < 0.0001）。
接受手术瓣膜置换的RIHD患者，无论使用机械瓣膜还是生物瓣膜，其短期和长期结局同样不理想。需要同时置换主动脉瓣和二尖瓣的患者10年总死亡率尤其高。有必要在更大的数据集中进行进一步研究，包括经导管治疗方法。
