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The role of cardiac surgery in radiation-associated heart disease: a scoping review

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Abstract

Background

Thoracic irradiation is an important tool in the treatment of breast cancer, non-Hodgkin’s lymphoma, and other cancers of the chest. The heart is commonly involved in these radiation fields, and young patients can present with severe cardiac pathologies requiring surgical intervention. However, this population poses a high surgical risk due to involvement of mediastinal tissues, and there are no consensus guidelines on best practice management.

Aim

This review aims to summarise the current experience of surgical correction of radiation-associated heart disease. We explore outcomes, technique modifications and alternative therapies for the three primary procedures performed: coronary artery bypass grafting, valvular intervention and pericardiectomy.

Methods

OVID Medline and PubMed databases were comprehensively searched to identify all studies involving surgery in patients with prior chest radiotherapy. All relevant studies within the past 25 years have been discussed.

Conclusion

Irradiated patients have heightened peri-operative risk, but other than redo surgery, these operations are not as treacherous as once thought. Involvement of all layers of the heart, especially the myocardium, is such that long-term mortality suffers despite optimal surgical correction. The goal of surgery in this cohort should be for a quick and safe operation, rather than a technically difficult procedure aimed at longevity.

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Data availability

Datasets used for this study are included in Zhang et al. [11], Elbadawi et al. [37], Nauffal et al. [30] and Yazdchi et al. [10].

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  1. Department of Cardiothoracic Surgery, St Vincent’s Hospital Melbourne, St Vincent’s Health Australia, Melbourne, Australia

    Daniel Shell

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Shell, D. The role of cardiac surgery in radiation-associated heart disease: a scoping review. Gen Thorac Cardiovasc Surg 71, 629–638 (2023). https://doi.org/10.1007/s11748-023-01939-2

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