Meta-analysis of surgical treatment of valvular pathology after radiotherapy for cancer of the mediastinal organs

Authors: Muratov R.M., Babenko S.I., Sorkomov M.N., Sachkov A.S.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2023-17-4-453-463

For citation: Muratov R.M., Babenko S.I., Sorkomov M.N., Sachkov A.S. Meta-analysis of surgical treatment of valvular pathology after radiotherapy for cancer of the mediastinal organs. Creative Cardiology. 2023; 17 (4): 453–63 (in Russ.). DOI: 10.24022/1997-3187-2023-17-4-453-463

Received / Accepted:  04.08.2023 / 24.10.2023

Keywords: radiation injury of the heart aquired heart disease hospital mortality long-term survival

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Abstract

Adequate irradiation of target tissues during radiation therapy for oncological diseases of the chest organs requires the inclusion of a certain volume of heart structures in the irradiation field. The use of various sources of electromagnetic waves, fractionation schemes and volumes of irradiation have different effects on the mediastinal organs, causing various pathological conditions.

A search was made in the PubMed (MEDLINE), Google Scholar databases for studies that examined the immediate results and long-term survival of patients who underwent cardiac surgery for valvular heart disease resulting from radiation injury during the treatment of thoracic cancer. Hazard ratio (HR) from studies where – in-hospital and long-term mortality data were available were pooled for the meta-analysis.

3 studies were selected, of which 654 patients were identified out of 1931 that were analyzed by the authors. The average follow-up period for patients ranged from 3.3 to 9.51 years. Meta-analysis showed a significant deterioration in the survival of patients who underwent radiation therapy in comparison with the control group at all stages of the postoperative period: hospital stage HR 5 (95% confidence interval (CI) 1.9–13.16, p=0.001), long-term period HR 4.22 (95% CI 1.14–15.57, p<0.00001).

The deterioration of early and long-term postoperative results of surgical treatment of patients with post-radiation heart damage confirms the need for earlier surgical treatment of valvular pathology before the development of post-radiation myocardial fibrosis.

References

  1. Chello M., Mastroroberto P., Romano R., Zofrea S., Bevacqua I., Marchese A.R. Changes in the proportion of types I and III collagen in the left ventricular wall of patients with postirradiative pericarditis. Cardiovasc. Surg. 1996; 4 (2): 222–6. DOI: 10.1016/0967-2109(96)82320-9
  2. Hinz B., Gabbiani G. Mechanisms of force generation and transmission by myofibroblasts. Curr. Opin. Biotechnol. 2003; 14 (5): 538–46. DOI: 10.1016/j.copbio.2003.08.006
  3. Boerma M., Roberto K.A., Hauer-Jensen M. Prevention and treatment of functional and structural radiation injury in the rat heart by pentoxifylline and alpha-tocopherol. Int. J. Rad Oncol. Biol. Phys. 2008; 72 (1): DOI: 10.1016/j.ijrobp.2008.04.042
  4. Cutter D.J., Ramroth J., Diez P., Buckle A., Ntentas G., Popova B. et al. Predicted risks of cardiovascular disease following chemotherapy and radiotherapy in the UK NCRI RAPID trial of positron emission tomography-directed therapy for early-stage hodgkin lymphoma. J. Clin. Oncol. 2021; 39 (32): 3591–601. DOI: 10.1200/JCO.21.00408
  5. Moher D., Liberati A., Tetzlaff J., Altman D.G. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med. 2009; 6 (7): e1000097. DOI: 10.1371/journal.pmed.1000097
  6. Rebrova O.Yu., Fediaeva V.K. The questionnaire to assess the risk of systematic bias in non-randomized comparative studies: the russian-language version of the Newcastle-Ottawa Scale. Medical Technologies. Evaluation and Selection. 2016; 3: 14–9.
  7. Ejiofor J.I., Ramirez-Del Val F., Nohria A., Norman A., McGurk S., Aranki S.F. et al. The risk of reoperative cardiac surgery in radiation-induced valvular disease. J. Thorac. Cardiovasc. Surg. 2017; 154 (6): 1883–95. DOI: 10.1016/j.jtcvs.2017.07.033
  8. Donnellan E., Masri A., Johnston D.R., Pettersson G.B., Rodriguez L.L., Popovic Z.B. et al. Long-term outcomes of patients with mediastinal radiation-associated severe aortic stenosis and subsequent surgical aortic valve replacement: a matched cohort study. J. Am. Heart Assoc. 2017; 6 (5): e005396. DOI: 10.1161/JAHA.116.005396
  9. Brown J.A., Aranda-Michel E., Kilic A., Serna-Gallegos D., Bianco V., Thoma F.W., Sultan I. Impact of thoracic radiation on patients undergoing cardiac surgery. Semin. Thorac. Cardiovasc. Surg. 2022; 34 (1): 136–43. DOI: 10.1053/j.semtcvs.2021.01.008
  10. Chang A.S., Smedira N.G., Chang C.L., Benavides M.M., Myhre U., Feng J. et al. Cardiac surgery after mediastinal radiation: extent of exposure influences outcome. J. Thorac. Cardiovasc. Surg. 2007; 133 (2): 404–13. DOI: 10.1016/j.jtcvs.2006.09.041
  11. Muratov R.M., Sorkomov M.N., Babenko S.I., Serov R.A., Zharikova A.E., Terekhov M.I. Early postoperative results of cardiac surgery in patients with previous radiotherapy for Hodgkin’s lymphoma. Kardiologiya i Serdechno-Sosudistaya Khirurgiya (Cardiology and Cardiovascular Surgery). 2022; 15 (1): 32–9 (in Russ.). DOI: 10.17116/kardio20221501132
  12. Desai M.Y., Wu W., Masri A., Popovic Z.B., Agarwal S., Smedira N.G. et al. Increased aorto-mitral curtain thickness independently predicts mortality in patients with radiation-associated cardiac disease undergoing cardiac surgery. Ann. Thorac. Surg. 2014; 97 (4): 1348–55. DOI: 10.1016/j.athoracsur.2013.12.029
  13. Desai M.Y., Karunakaravel K., Wu W., Agarwal S., Smedira N.G., Lytle B.W., Griffin B.P. Pulmonary fibrosis on multidetector computed tomography and mortality in patients with radiationassociated cardiac disease undergoing cardiac surgery. J. Thorac. Cardiovasc. Surg. 2014; 148 (2): 475–81.e3. DOI: 10.1016/j.jtcvs.2013.08.087
  14. Van Rijswijk J.W., Farag E.S., Bouten C.V.C., de Boer O.J., van der Wal A., de Mol B.A.J.M., Kluin J. Fibrotic aortic valve disease after radiotherapy: an immunohistochemical study in breast cancer and lymphoma patients. Cardiovasc. Pathol. 2020; 45: 107176. DOI: 10.1016/j.carpath.2019.107176
  15. Muratov R.M., Babenko S.I., Sorkomov M.N. Current view on radiation-induced heart disease and methods of its diagnosis. Russian Journal of Transplantology and Artificial Organs. 2022; 24 (4): 39–45. DOI: 10.15825/1995-1191-2022-4-39-45
  16. Pahwa S., Crestanello J., Bernabei A., Schaff H., Dearani J., Lahr B., Greason K. Mitral valve repair vs replacement in patients with previous mediastinal irradiation. Semin. Thorac. Cardiovasc. Surg. 2022; 34 (4): 1197–204. DOI: 10.1053/j.semtcvs.2021.09.002

About Authors

  • Ravil M. Muratov, Dr. Med. Sci., Professor, Head of Department; ORCID
  • Svetlana I. Babenko, Dr. Med. Sci., Leading Researcher; ORCID
  • Maksim N. Sorkomov, Cardiovascular Surgeon; ORCID
  • Anton S. Sachkov, Cand. Med. Sci., Researcher; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery