Cardiac transplantation for radiation-induced cardiomyopathy

The Mayo Clinic experience

Pankaj Saxena, Lyle D. Joyce, Richard C. Daly, Sudhir S. Kushwaha, John A. Schirger, Jordan Rosedahl, Joseph A. Dearani, Tomas Kara, Brooks Sayre Edwards

Research output: Contribution to journalArticle

15 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2115-2121
Number of pages7
JournalAnnals of Thoracic Surgery
Volume98
Issue number6
DOIs
StatePublished - Dec 1 2014

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Heart Transplantation
Cardiomyopathies
Radiation
Respiratory Insufficiency
Wounds and Injuries
Restrictive Cardiomyopathy
Constrictive Pericarditis
Neoplasms
Mediastinum
Splenectomy
Adjuvant Chemotherapy
Hospital Mortality
Treatment Failure
Lung Diseases
Renal Insufficiency
Coronary Artery Disease
Heart Diseases
Lymphoma
Radiotherapy
Heart Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Cardiac transplantation for radiation-induced cardiomyopathy : The Mayo Clinic experience. / Saxena, Pankaj; Joyce, Lyle D.; Daly, Richard C.; Kushwaha, Sudhir S.; Schirger, John A.; Rosedahl, Jordan; Dearani, Joseph A.; Kara, Tomas; Edwards, Brooks Sayre.

In: Annals of Thoracic Surgery, Vol. 98, No. 6, 01.12.2014, p. 2115-2121.

Research output: Contribution to journalArticle

Saxena, P, Joyce, LD, Daly, RC, Kushwaha, SS, Schirger, JA, Rosedahl, J, Dearani, JA, Kara, T & Edwards, BS 2014, 'Cardiac transplantation for radiation-induced cardiomyopathy: The Mayo Clinic experience', Annals of Thoracic Surgery, vol. 98, no. 6, pp. 2115-2121. https://doi.org/10.1016/j.athoracsur.2014.06.056
Saxena, Pankaj ; Joyce, Lyle D. ; Daly, Richard C. ; Kushwaha, Sudhir S. ; Schirger, John A. ; Rosedahl, Jordan ; Dearani, Joseph A. ; Kara, Tomas ; Edwards, Brooks Sayre. / Cardiac transplantation for radiation-induced cardiomyopathy : The Mayo Clinic experience. In: Annals of Thoracic Surgery. 2014 ; Vol. 98, No. 6. pp. 2115-2121.
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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.",
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N2 - 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.

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