Frequency of severe valvular disease caused by mediastinal radiation among patients undergoing valve surgery in a community-based, regional academic medical center.

BACKGROUND: Our goal was to define the prevalence of radiation-induced valvular heart (RIVD) disease among patients undergoing cardiac valve surgery in a community-based, regional academic medical center. Mediastinal radiation is a treatment modality for various hematologic and solid malignancies; however, long-term cardiac complications, including radiation-induced valvular heart disease, can occur years after the radiation treatments. HYPOTHESIS: Mediastinal radiation exposure is an independent risk factor for valvular heart disease often necessitating valve replacement in patients without other risk factors for valve disease. METHODS: Between January 1, 1998 and September 1, 2007, we retrospectively analyzed our institution's cardiac surgical database over a 10 year period and identified 189 consecutive patients ≤ 50 years of age who underwent valve surgery. Using case-control matching, we assessed the prevalence of mediastinal radiation among these young patients with valve disease necessitating surgery and to their matched controls from all patients admitted to the hospital. RESULTS: Nine individuals (4.8%) were identified as having received previous mediastinal radiation, significantly increased from controls (p<0.0001), and 8 of whom had surgical or pathologic findings consistent with radiation damage. Compared with a matched case-control population, individuals who had severe valve disease and underwent valve replacement had a markedly increased prevalence of prior mediastinal radiation therapy. CONCLUSIONS: In conclusion, cardiologists must remain aware of the potential long term valvular complications in patients treated with mediastinal radiation. Increased surveillance for RIVD may be considered in the decades following radiation therapy.

Long-term follow-up of polytetrafluoroethylene-covered stents implanted during percutaneous coronary intervention for management of acute coronary perforation.

OBJECTIVE: To determine the long-term outcomes for patients receiving polytetrafluoroethylene (PTFE)-covered stents as definitive therapy, in our institution, for the management of acute coronary perforation. BACKGROUND: Coronary perforation as a complication of percutaneous coronary intervention (PCI) is associated with high morbidity and mortality. Management options included observation only or a combination of several or all of these approaches: reversal of anticoagulation, prolonged balloon inflation, deployment of a standard stent, emergent cardiac surgery, or insertion of a PTFE-covered stent. METHODS: With our IRB approval, records of 12,093 consecutive patients who received PCI during a 5-year period from January 2002 to December 2006 were reviewed and 50 patients who had coronary perforation as a complication of PCI were identified. RESULTS: Of the 21 patients who received a PTFE-covered stent to manage coronary perforation, one died secondary to acute thrombosis within the PTFE-covered stent in the first 24 hrs and one required emergent cardiac surgery due to continued contrast extravasation despite PTFE-covered stent deployment. The other 19 patients were followed long term (mean 55 months) and only one survivor had a potentially life-threatening outcome (subacute stent thrombosis) over that time period. CONCLUSION: Utilization of a PTFE-covered stent may be a reasonable short- and long-term option to manage acute coronary perforation that occurs during PCI. On the basis of this limited experience, successful PTFE-covered stent deployment as the conclusive treatment for coronary perforation is associated with a favorable long-term event-free survival rate.