Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy

Juan A. Crestanello, Christopher G A McGregor, Gordon K. Danielson, Richard C. Daly, Joseph A. Dearani, Thomas A. Orszulak, Charles J. Mullany, Francisco J. Puga, Kenton J. Zehr, Cathy Schleck, Hartzell V Schaff

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background The purpose of this study was to evaluate outcomes of mitral and tricuspid valve repair after mediastinal radiation therapy. Methods From 1976 to 2001, 22 patients (mean age 61 ± 14 years) underwent mitral (n = 14), tricuspid (n = 6), or both (n = 2) valve repairs 15 ± 9 years after mediastinal radiation therapy. Concomitant procedures included coronary artery bypass graft, 11 patients; valve replacement, 6 patients (4 aortic, 3 mitral, 1 tricuspid, and 1 pulmonary); and pericardiectomy, 4 patients. Results Total follow-up was 82.5 patient-years (mean 3.7 ± 3.3 years). Early mortality was 3 patients. There were 7 late deaths, 4 of which were of cardiovascular origin. Of the 19 early survivors, 2 required subsequent valve replacements, and 1 required cardiac transplantation 3.4 ± 2.8 years after valve repair. One patient died after reoperation. In 4 patients who did not undergo reoperation, echocardiographic examinations showed progressive deterioration of their repaired valve function. Overall survival, freedom from cardiac death, and freedom from valve reoperation or cardiac transplantation at 5 years for early survivors was 66%, 85%, and 88%, respectively. New York Heart Association functional class at follow-up was I or II in 8 of the 12 late survivors. Conclusions Functional status was good in two-thirds of late survivors. However, severe dysfunction of the repaired valve developed in 32% of early survivors and 16% required further surgery. Valve repair is technically feasible in selected patients after mediastinal radiation therapy; however, the limited durability of repairs after mediastinal radiation in this series suggests that valve replacement might be preferable.

Original languageEnglish (US)
Pages (from-to)826-831
Number of pages6
JournalAnnals of Thoracic Surgery
Volume78
Issue number3
DOIs
StatePublished - Sep 2004

Fingerprint

Tricuspid Valve
Mitral Valve
Radiotherapy
Survivors
Reoperation
Heart Transplantation
Pericardiectomy
Coronary Artery Bypass
Radiation
Transplants
Lung
Survival
Mortality

Keywords

  • 35

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Crestanello, J. A., McGregor, C. G. A., Danielson, G. K., Daly, R. C., Dearani, J. A., Orszulak, T. A., ... Schaff, H. V. (2004). Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy. Annals of Thoracic Surgery, 78(3), 826-831. https://doi.org/10.1016/j.athoracsur.2004.04.008

Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy. / Crestanello, Juan A.; McGregor, Christopher G A; Danielson, Gordon K.; Daly, Richard C.; Dearani, Joseph A.; Orszulak, Thomas A.; Mullany, Charles J.; Puga, Francisco J.; Zehr, Kenton J.; Schleck, Cathy; Schaff, Hartzell V.

In: Annals of Thoracic Surgery, Vol. 78, No. 3, 09.2004, p. 826-831.

Research output: Contribution to journalArticle

Crestanello, JA, McGregor, CGA, Danielson, GK, Daly, RC, Dearani, JA, Orszulak, TA, Mullany, CJ, Puga, FJ, Zehr, KJ, Schleck, C & Schaff, HV 2004, 'Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy', Annals of Thoracic Surgery, vol. 78, no. 3, pp. 826-831. https://doi.org/10.1016/j.athoracsur.2004.04.008
Crestanello JA, McGregor CGA, Danielson GK, Daly RC, Dearani JA, Orszulak TA et al. Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy. Annals of Thoracic Surgery. 2004 Sep;78(3):826-831. https://doi.org/10.1016/j.athoracsur.2004.04.008
Crestanello, Juan A. ; McGregor, Christopher G A ; Danielson, Gordon K. ; Daly, Richard C. ; Dearani, Joseph A. ; Orszulak, Thomas A. ; Mullany, Charles J. ; Puga, Francisco J. ; Zehr, Kenton J. ; Schleck, Cathy ; Schaff, Hartzell V. / Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy. In: Annals of Thoracic Surgery. 2004 ; Vol. 78, No. 3. pp. 826-831.
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abstract = "Background The purpose of this study was to evaluate outcomes of mitral and tricuspid valve repair after mediastinal radiation therapy. Methods From 1976 to 2001, 22 patients (mean age 61 ± 14 years) underwent mitral (n = 14), tricuspid (n = 6), or both (n = 2) valve repairs 15 ± 9 years after mediastinal radiation therapy. Concomitant procedures included coronary artery bypass graft, 11 patients; valve replacement, 6 patients (4 aortic, 3 mitral, 1 tricuspid, and 1 pulmonary); and pericardiectomy, 4 patients. Results Total follow-up was 82.5 patient-years (mean 3.7 ± 3.3 years). Early mortality was 3 patients. There were 7 late deaths, 4 of which were of cardiovascular origin. Of the 19 early survivors, 2 required subsequent valve replacements, and 1 required cardiac transplantation 3.4 ± 2.8 years after valve repair. One patient died after reoperation. In 4 patients who did not undergo reoperation, echocardiographic examinations showed progressive deterioration of their repaired valve function. Overall survival, freedom from cardiac death, and freedom from valve reoperation or cardiac transplantation at 5 years for early survivors was 66{\%}, 85{\%}, and 88{\%}, respectively. New York Heart Association functional class at follow-up was I or II in 8 of the 12 late survivors. Conclusions Functional status was good in two-thirds of late survivors. However, severe dysfunction of the repaired valve developed in 32{\%} of early survivors and 16{\%} required further surgery. Valve repair is technically feasible in selected patients after mediastinal radiation therapy; however, the limited durability of repairs after mediastinal radiation in this series suggests that valve replacement might be preferable.",
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AU - Dearani, Joseph A.

AU - Orszulak, Thomas A.

AU - Mullany, Charles J.

AU - Puga, Francisco J.

AU - Zehr, Kenton J.

AU - Schleck, Cathy

AU - Schaff, Hartzell V

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N2 - Background The purpose of this study was to evaluate outcomes of mitral and tricuspid valve repair after mediastinal radiation therapy. Methods From 1976 to 2001, 22 patients (mean age 61 ± 14 years) underwent mitral (n = 14), tricuspid (n = 6), or both (n = 2) valve repairs 15 ± 9 years after mediastinal radiation therapy. Concomitant procedures included coronary artery bypass graft, 11 patients; valve replacement, 6 patients (4 aortic, 3 mitral, 1 tricuspid, and 1 pulmonary); and pericardiectomy, 4 patients. Results Total follow-up was 82.5 patient-years (mean 3.7 ± 3.3 years). Early mortality was 3 patients. There were 7 late deaths, 4 of which were of cardiovascular origin. Of the 19 early survivors, 2 required subsequent valve replacements, and 1 required cardiac transplantation 3.4 ± 2.8 years after valve repair. One patient died after reoperation. In 4 patients who did not undergo reoperation, echocardiographic examinations showed progressive deterioration of their repaired valve function. Overall survival, freedom from cardiac death, and freedom from valve reoperation or cardiac transplantation at 5 years for early survivors was 66%, 85%, and 88%, respectively. New York Heart Association functional class at follow-up was I or II in 8 of the 12 late survivors. Conclusions Functional status was good in two-thirds of late survivors. However, severe dysfunction of the repaired valve developed in 32% of early survivors and 16% required further surgery. Valve repair is technically feasible in selected patients after mediastinal radiation therapy; however, the limited durability of repairs after mediastinal radiation in this series suggests that valve replacement might be preferable.

AB - Background The purpose of this study was to evaluate outcomes of mitral and tricuspid valve repair after mediastinal radiation therapy. Methods From 1976 to 2001, 22 patients (mean age 61 ± 14 years) underwent mitral (n = 14), tricuspid (n = 6), or both (n = 2) valve repairs 15 ± 9 years after mediastinal radiation therapy. Concomitant procedures included coronary artery bypass graft, 11 patients; valve replacement, 6 patients (4 aortic, 3 mitral, 1 tricuspid, and 1 pulmonary); and pericardiectomy, 4 patients. Results Total follow-up was 82.5 patient-years (mean 3.7 ± 3.3 years). Early mortality was 3 patients. There were 7 late deaths, 4 of which were of cardiovascular origin. Of the 19 early survivors, 2 required subsequent valve replacements, and 1 required cardiac transplantation 3.4 ± 2.8 years after valve repair. One patient died after reoperation. In 4 patients who did not undergo reoperation, echocardiographic examinations showed progressive deterioration of their repaired valve function. Overall survival, freedom from cardiac death, and freedom from valve reoperation or cardiac transplantation at 5 years for early survivors was 66%, 85%, and 88%, respectively. New York Heart Association functional class at follow-up was I or II in 8 of the 12 late survivors. Conclusions Functional status was good in two-thirds of late survivors. However, severe dysfunction of the repaired valve developed in 32% of early survivors and 16% required further surgery. Valve repair is technically feasible in selected patients after mediastinal radiation therapy; however, the limited durability of repairs after mediastinal radiation in this series suggests that valve replacement might be preferable.

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