title: Cardiac transplantation for radiation-induced cardiomyopathy: the Mayo Clinic experience.
abstract: BACKGROUND
  High-dose radiotherapy to the mediastinum for the treatment of malignancies causes injury to the intrathoracic organs. Coronary artery disease, valvular dysfunction, cardiomyopathy, and chronic constrictive pericarditis are common cardiovascular sequelae during long-term follow-up. Cardiac transplantation is indicated for the surgical treatment of heart failure due to radiation-induced end-stage cardiac disease.
  
  
  METHODS
  A retrospective study of radiation-induced cardiomyopathy requiring cardiac transplantation was undertaken from December 1992 to August 2010.
  
  
  RESULTS
  Twelve patients (7 men, 5 women), with a mean age of 47.4 years, underwent orthotopic cardiac transplantation. Redo cardiac operations were performed in 9 patients. Lymphoma was the primary malignancy in all patients. Adjuvant chemotherapy was used in 9 patients, and splenectomy was performed in 7. Restrictive cardiomyopathy (n = 8) was the predominant diagnosis. Restrictive lung disease was present in 10 patients (83%). Postoperative chronic kidney injury developed in 3 patients (25%). Hospital mortality was 8.3%. Survival at 1, 5, and 10 years was 91.7%, 75%, and 46.7%, respectively. The overall mean follow-up was 7.7 years (median, 6.1; range, 1.8 to 16.4 years). Late respiratory failure accounted for 3 deaths.
  
  
  CONCLUSIONS
  Cardiac transplantation provides satisfactory medium-term to long-term outcome in patients with radiation-induced cardiomyopathy. Secondary malignancies, kidney injury, and respiratory failure contribute to significant postoperative morbidity and death.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Saxena
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Joyce
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.affiliation: Division of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
authors.affiliation: Division of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: John A
authors.initials: JA
authors.lastname: Schirger
authors.affiliation: Department of Biostatistics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jordan
authors.initials: J
authors.lastname: Rosedahl
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: International Clinical Research Center, Department of Cardiovascular Diseases, St. Anne's University Hospital, Brno, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Kara
authors.affiliation: Division of Cardiology, Mayo Clinic, Rochester, Minnesota. Electronic address: edwards.brooks@mayo.edu.
authors.forename: Brooks S
authors.initials: BS
authors.lastname: Edwards
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008223:Lymphoma / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011832:Radiation Injuries / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome