The prognosis after heart surgery may be worse for cancer survivors with cardiac damage from radiation treatments, an observational study suggested.

Despite similar presurgical risk scores, 55% of patients died in the 8 years following surgery to correct radiation-associated heart disease compared with 28% mortality among other heart surgery patients (P<0.001), Milind Desai, MD, of the Cleveland Clinic Heart and Vascular Institute, and colleagues found.

Heart disease caused by radiation predicted 2.5-fold elevated mortality risk, the group reported online in Circulation: Journal of the American Heart Association.

"Our findings suggest that surgical intervention should be applied cautiously to patients who have had significant thoracic radiation previously," they wrote, "as the realized survival do not necessarily match what would be expected in a nonradiated population."

These patients may need alternative treatment strategies, Desai and colleagues suggested.

For example, "a percutaneous transaortic approach may circumvent specific technical difficulties such as extensive calcification of the ascending aorta that may occur with radiation disease and reduces the likelihood of lung or pleural damage from surgery," they noted.

Prior studies have suggested up to 42% of patients who get thoracic radiation develop significant valvular disease and 14% develop stress-induced myocardial ischemia. Other long-term effects of radiation can include pericardial disease and conduction disease as well as problems with the lungs and the great vessels and carotid arteries.

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