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Cardiac surgery with extracorporeal circulation and concomitant malignancy: early and long-term results analysis.

Nardi, Paolo; Pellegrino, Antonio; Pugliese, Marta; Bovio, Emanuele; Chiariello, Luigi; Ruvolo, Giovanni
Journal of Cardiovascular Medicine: Post Author Corrections: November 7, 2015
doi: 10.2459/JCM.0000000000000319
Original article: PDF Only

Aims: We retrospectively evaluated early and long-term results of cardiac surgery using extracorporeal circulation (ECC) in patients affected by malignancies and the potential influence of ECC on malignancy progression during follow-up.

Methods: Out of 7078 patients referred for cardiac surgery from January 2001 to December 2012, 241 consecutive patients (3.4%) (mean age 72 +/- 8 years; men 170) had malignancy either known before or detected during hospital stay. Organ malignancies were present in 201 patients (83%) and hematological malignancies in 40 (17%). Early stages of cancer (I-II, in remission) were present in 180 (75%) patients, and advanced stages (III-IV for organ malignancies , multiple organ involvement for hematological malignancies) in 61 (25%). EuroSCORE I and II were 8.6 +/- 5.4 and 3.8 +/- 2.1%, respectively. Cardiac surgery with ECC consisted in isolated (n = 176) or multiple procedures (n = 65). Follow-up (mean 57 +/- 40 months) was 99% complete.

Results: In-hospital mortality was 5.8% (n = 14); 1.67% (n = 4) died from cancer-related causes. Ten-year survival was 65 +/- 5%, and freedom from cardiac death was 92 +/- 3.5%. Freedom from cancer-related death was 90 +/- 3% for patients operated on in early stages of cancer compared with 60 +/- 8.4% for those who operated on in advanced stages (P < 0.0001), and 89 +/- 2.6% for organ malignancies compared with 48 +/- 13% for hematological malignancies (P = 0.0002); hematological malignancies different from Hodgkin/non-Hodgkin lymphoma affected long-term survival (P < 0.05). Progression of malignancy was observed in 29 patients (12.8%) at 18 +/- 10 months.

Conclusion: Cardiac surgery in cancer patients is not associated with increased in-hospital mortality and provides satisfactory freedom from cardiac death. Long-term survival in early stages of cancer appears satisfactory. Time interval between ECC and progression of malignancy during follow-up should apparently exclude a close relationship of ECC on cancer progression. Hematological malignancies seem to have a negative impact on the overall outcome.

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