2013年4月8日—據(jù)《美國心臟學(xué)會》（American Heart Association）雜志發(fā)表的一項(xiàng)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(shù)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(shù)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(xué)副教授,，研究創(chuàng)始人Milind Desai博士說道：早在20世紀(jì)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(fù)面影響。與未接受放療的患者相比,，放療患者發(fā)展為進(jìn)行性冠狀動脈疾病,、惡性心瓣膜病、心包疾病的風(fēng)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(shù)。
此項(xiàng)研究是評估前期放療對大型心臟手術(shù)長期影響的最大規(guī)模試驗(yàn),。研究人員對需要心臟手術(shù)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(shù)平均間隔時間為18年。研究人員對這些心臟手術(shù)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(shù)的305例患者進(jìn)行對比,。
Desai稱：這些手術(shù)多為心內(nèi)直視手術(shù),，包括瓣膜或旁路手術(shù),，其中大部分為多項(xiàng)同步手術(shù)；例如多瓣膜手術(shù)或瓣膜加旁路手術(shù),。約1/4患者需要重做手術(shù),，這將增加已接受初次手術(shù)患者的死亡風(fēng)險。
放療患者的術(shù)前評分與非放療患者相似,。通常情況下,，術(shù)前評分有助于預(yù)測患者術(shù)后病情進(jìn)展。無論患者術(shù)前是否接受放療,，患者在術(shù)后30天內(nèi)的預(yù)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(dá)55%,，而未放療患者死亡率僅為28%。
Desai表示：該結(jié)果證實(shí),，盡管術(shù)前風(fēng)險評分較低,，但放療可增加大型心臟手術(shù)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(shù)對患者有益,；某些患者可能更適宜經(jīng)皮穿刺手術(shù)。（生物谷Bioon.com）
doi: 10.1161/?CIRCULATIONAHA.113.001435
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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.
