title: Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy.
abstract: BACKGROUND
  The purpose of this study was to evaluate outcomes of mitral and tricuspid valve repair after mediastinal radiation therapy.
  
  
  METHODS
  From 1976 to 2001, 22 patients (mean age 61 +/- 14 years) underwent mitral (n = 14), tricuspid (n = 6), or both (n = 2) valve repairs 15 +/- 9 years after mediastinal radiation therapy. Concomitant procedures included coronary artery bypass graft, 11 patients; valve replacement, 6 patients (4 aortic, 3 mitral, 1 tricuspid, and 1 pulmonary); and pericardiectomy, 4 patients.
  
  
  RESULTS
  Total follow-up was 82.5 patient-years (mean 3.7 +/- 3.3 years). Early mortality was 3 patients. There were 7 late deaths, 4 of which were of cardiovascular origin. Of the 19 early survivors, 2 required subsequent valve replacements, and 1 required cardiac transplantation 3.4 +/- 2.8 years after valve repair. One patient died after reoperation. In 4 patients who did not undergo reoperation, echocardiographic examinations showed progressive deterioration of their repaired valve function. Overall survival, freedom from cardiac death, and freedom from valve reoperation or cardiac transplantation at 5 years for early survivors was 66%, 85%, and 88%, respectively. New York Heart Association functional class at follow-up was I or II in 8 of the 12 late survivors.
  
  
  CONCLUSIONS
  Functional status was good in two-thirds of late survivors. However, severe dysfunction of the repaired valve developed in 32% of early survivors and 16% required further surgery. Valve repair is technically feasible in selected patients after mediastinal radiation therapy; however, the limited durability of repairs after mediastinal radiation in this series suggests that valve replacement might be preferable.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55906, USA.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Crestanello
authors.forename: Christopher G A
authors.initials: CG
authors.lastname: McGregor
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Danielson
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Orszulak
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Mullany
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Puga
authors.forename: Kenton J
authors.initials: KJ
authors.lastname: Zehr
authors.forename: Cathy
authors.initials: C
authors.lastname: Schleck
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology / Q000532:radiotherapy; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery*; D006689:Hodgkin Disease / Q000453:epidemiology / Q000532:radiotherapy; D006801:Humans; D007902:Length of Stay; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology / Q000532:radiotherapy; D008297:Male; D008479:Mediastinal Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy*; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011832:Radiation Injuries / Q000453:epidemiology*; D012086:Reoperation; D016019:Survival Analysis; D015996:Survival Rate; D014261:Tricuspid Valve / Q000601:surgery*