Heart Surgery Risk for Cancer Survivors

Cancer survivors who had radiation may have increased risks following heart surgery

(RxWiki News) Radiation therapy has helped many patients fight cancer. However, the treatment often takes a toll on the heart and affects survival rates for those who have heart surgery.

One of the most common and effective methods to kill cancer cells is through high doses of radiation. While chest radiation can help shrink breast cancer and other tumors, it can also damage the heart.

Scientists recently reported that cancer survivors who had chest radiation therapy were nearly twice as likely to die in the years following major heart surgery.

"Ask a cardiologist any heart surgey questions."

Milind Desai, MD, associate professor of medicine at the Cleveland Clinic in Ohio, led the review of 173 patients who had had radiation treatment for cancer an average 18 years before needing heart surgery.

Dr. Desai and fellow investigators followed the heart surgery patients an average 7.6 years and compared them to 305 patients undergoing similar heart surgeries who did not have radiation therapy.

The surgeries were all major procedures, such as valve and bypass surgeries. About a quarter of the surgeries were “re-do” operations, which put patients at higher risk than those having initial procedures.

Patients had similar results in the first 30 days after major cardiac surgery no matter their prior radiation status. During the entire follow-up, 55 percent of patients in the radiation group died, compared to 28 percent in the non-radiation group.

“Cancer survivors are at greater risk than people who do not have radiation to develop progressive coronary artery disease, aggressive valvular disease, as well as pericardial diseases (inflammation of sac surround the heart),” said Dr. Desai. “These conditions often require major cardiac surgery."

Even patients going into surgery with a relatively low preoperative risk score were more likely to die if they received radiation therapy in the past.  

“In patients who have had prior thoracic [chest] radiation, we need to develop better strategies of identifying appropriate patients that would benefit from surgical intervention,” said Dr. Desai.

“Alternatively, some patients might be better suited for percutaneous (via needle puncture of the skin) procedures.”

Angioplasty is a common percutaneous non-surgical procedure in which an artery that is narrowed by plaque buildup is widened by passing a catheter through the skin and into a blood vessel. A balloon near the end of the catheter expands and opens the artery; a stent (small mesh tube) is inserted into the blood vessel to keep it open.

The study was published in April in the American Heart Association journal Circulation.

Review Date: 
April 9, 2013