title: Long-term survival of patients with radiation heart disease undergoing cardiac surgery: a cohort study.
abstract: BACKGROUND
  Thoracic radiation results in radiation-associated heart disease (RAHD), often requiring cardiothoracic surgery (CTS). We sought to measure long-term survival in RAHD patients undergoing CTS, to compare them with a matched control population undergoing similar surgical procedures, and to identify potential predictors of long-term survival.
  
  
  RESULTS
  In this retrospective observational cohort study of patients undergoing CTS, matched on the basis of age, sex, and type/time of CTS, 173 RAHD patients (75% women; age, 63±14 years) and 305 comparison patients (74% women; age, 63±4 years) were included. The vast majority of RAHD patients had prior breast cancer (53%) and Hodgkin lymphoma (27%), and the mean time from radiation was 18±12 years. Clinical and surgical parameters were recorded. The preoperative EuroSCORE and all-cause mortality were recorded. The mean EuroSCOREs were similar in the RAHD and comparison groups (7.8±3 versus 7.4±3, respectively; P=0.1). Proximal coronary artery disease was higher in patients with RAHD versus the comparison patients (45% versus 38%; P=0.09), whereas redo CTS was lower in the RACD versus the comparison group (20% versus 29%; P=0.02). About two thirds of patients in either group had combination surgical procedures. During a mean follow-up of 7.6±3 years, a significantly higher proportion of patients died in the RAHD group than in the comparison group (55% versus 28%; P<0.001). On multivariable Cox proportional hazard analysis, RAHD (2.47; 95% confidence interval, 1.82-3.36), increasing EuroSCORE (1.22; 95% confidence interval, 1.16-1.29), and lack of β-blockers (0.66; 95% confidence interval, 0.47-0.93) were associated with increased mortality (all P<0.01).
  
  
  CONCLUSIONS
  In patients undergoing CTS, RAHD portends increased long-term mortality. Alternative treatment strategies may be required in RAHD to improve long-term survival.
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Willis
authors.initials: W
authors.lastname: Wu
authors.forename: Ahmad
authors.initials: A
authors.lastname: Masri
authors.forename: Zoran B
authors.initials: ZB
authors.lastname: Popovic
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Smedira
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
authors.forename: Brian P
authors.initials: BP
authors.lastname: Griffin
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000532:radiotherapy; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D006689:Hodgkin Disease / Q000401:mortality* / Q000532:radiotherapy; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000150:complications / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors