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Mitral Valve Repair vs Replacement in Patients with Previous Mediastinal Irradiation
Seminars in Thoracic and Cardiovascular Surgery  (IF2.006),  Pub Date : 2021-09-08, DOI: 10.1053/j.semtcvs.2021.09.002
Siddharth Pahwa, Juan Crestanello, Annalisa Bernabei, Hartzell Schaff, Joseph Dearani, Brian Lahr, Kevin Greason

Long-term outcomes of mitral valve surgery after mediastinal radiation therapy (MRT) are not well characterized. We analyzed long-term survival in patients who underwent mitral valve repair or replacement after MRT. From 2001 to 2018, 148 patients underwent mitral valve surgery at our institution after MRT for cancer. The association between surgery group and survival was assessed using Cox proportional hazards modeling, with propensity score adjustment to control for clinical and operative differences between groups. Mitral valve was repaired in 48 (32.4%) and replaced in 100 (67.6%) patients. The groups (repair vs. replacement) were similar in age (62.0 vs 57.1 years, p=0.10), gender (female n=38, 79.2% vs n=65, 65%, p=0.08), chronic lung disease (n=12, 25.0% vs n=37, 37.0%, p=0.19), congestive heart failure (CHF) (n=13, 27.1% vs n=38, 38.4%, p=0.20), but differed in atrial fibrillation (n=17, 35.4% vs n=13, 13.0%, p=0.002), first cardiovascular surgery (n=34, 70.8% vs n=47, 47.0%, p=0.006), and time since MRT (median 12, 7-27 years, vs 30, 19-37 years, p<0.001). Long term survival was no different between groups in the unadjusted (p=0.835) and propensity-adjusted (p=0.645) analysis, and inferior to the expected survival of an age- and sex-matched population. Mediastinal irradiation negatively impacts survival in patients who undergo mitral valve surgery. The traditional advantage of mitral valve repair over replacement on long-term survival was not seen in patients with radiation associated mitral valve disease.