2013年4月8日—據(jù)《美國心臟學會》（American Heart Association）雜志發(fā)表的一項研究顯示,，與未接受放療的腫瘤患者相比，接受胸部放療的患者,，在接受心臟大型手術后數(shù)年內(nèi)死亡率增加近兩倍,。胸部放療能殺滅或縮小乳腺腫瘤、霍奇金淋巴瘤和其他腫瘤,；腫瘤患者接受放療后,，在接受大型心臟手術后數(shù)年甚至幾十年后的死亡率增加。
俄亥俄州的克利夫蘭診所醫(yī)學副教授,，研究創(chuàng)始人Milind Desai博士說道：早在20世紀60年代末,、70年代和80年代，放射治療在改善兒童和成年腫瘤患者生存方面發(fā)揮重要作用；但該療法往往對心臟有負面影響。與未接受放療的患者相比,，放療患者發(fā)展為進行性冠狀動脈疾病,、惡性心瓣膜病、心包疾病的風險更大,；這些病變均能影響心臟周圍結(jié)構(gòu)，且往往需要大型心臟手術。
此項研究是評估前期放療對大型心臟手術長期影響的最大規(guī)模試驗,。研究人員對需要心臟手術的173例放療的腫瘤患者開展回顧性研究，這些患者放療和心臟手術平均間隔時間為18年。研究人員對這些心臟手術患者平均隨訪7.6年,，并與未接受放療但接受類似心臟手術的305例患者進行對比,。
Desai稱：這些手術多為心內(nèi)直視手術，包括瓣膜或旁路手術,，其中大部分為多項同步手術,；例如多瓣膜手術或瓣膜加旁路手術。約1/4患者需要重做手術,，這將增加已接受初次手術患者的死亡風險,。
放療患者的術前評分與非放療患者相似。通常情況下,，術前評分有助于預測患者術后病情進展,。無論患者術前是否接受放療，患者在術后30天內(nèi)的預后情況相似,。但是,，在隨訪的7.6年間，接受放療的腫瘤患者死亡率高達55%,，而未放療患者死亡率僅為28%,。
Desai表示：該結(jié)果證實，盡管術前風險評分較低,，但放療可增加大型心臟手術死亡率,。醫(yī)生需為有胸部放療史的患者制定更適宜的治療方案，以確定心臟手術對患者有益,；某些患者可能更適宜經(jīng)皮穿刺手術,。（生物谷Bioon.com）
doi: 10.1161/?CIRCULATIONAHA.113.001435
PMC:
PMID:
Long-Term Survival of Patients With Radiation Heart Disease Undergoing Cardiac Surgery
Willis Wu, MD; Ahmad Masri, MD; Zoran B. Popovic, MD, PhD; Nicholas G. Smedira, MD; Bruce W. Lytle, MD; Thomas H. Marwick, MD, PhD; Brian P. Griffin, MD; Milind Y. Desai, MD
Background—Thoracic radiation results in radiation-associated heart disease (RAHD), often requiring cardiothoracic surgery (CTS). We sought to measure long-term survival in RAHD patients undergoing CTS, to compare them with a matched control population undergoing similar surgical procedures, and to identify potential predictors of long-term survival.
Methods and Results—In this retrospective observational cohort study of patients undergoing CTS, matched on the basis of age, sex, and type/time of CTS, 173 RAHD patients (75% women; age, 63±14 years) and 305 comparison patients (74% women; age, 63±4 years) were included. The vast majority of RAHD patients had prior breast cancer (53%) and Hodgkin lymphoma (27%), and the mean time from radiation was 18±12 years. Clinical and surgical parameters were recorded. The preoperative EuroSCORE and all-cause mortality were recorded. The mean EuroSCOREs were similar in the RAHD and comparison groups (7.8±3 versus 7.4±3, respectively; P=0.1). Proximal coronary artery disease was higher in patients with RAHD versus the comparison patients (45% versus 38%; P=0.09), whereas redo CTS was lower in the RACD versus the comparison group (20% versus 29%; P=0.02). About two thirds of patients in either group had combination surgical procedures. During a mean follow-up of 7.6±3 years, a significantly higher proportion of patients died in the RAHD group than in the comparison group (55% versus 28%; P<0.001). On multivariable Cox proportional hazard analysis, RAHD (2.47; 95% confidence interval, 1.82–3.36), increasing EuroSCORE (1.22; 95% confidence interval, 1.16–1.29), and lack of β-blockers (0.66; 95% confidence interval, 0.47–0.93) were associated with increased mortality (all P<0.01).
Conclusions—In patients undergoing CTS, RAHD portends increased long-term mortality. Alternative treatment strategies may be required in RAHD to improve long-term survival.
