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.

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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