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

Nardi, Paolo; Pellegrino, Antonio; Pugliese, Marta; Bovio, Emanuele; Chiariello, Luigi; Ruvolo, Giovanni

Journal of Cardiovascular Medicine: February 2016 - Volume 17 - Issue 2 - p 152–159
doi: 10.2459/JCM.0000000000000319
Cardiac surgery

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.

Cardiac Surgery Unit, Tor Vergata University Policlinic of Rome, Rome, Italy

Correspondence to Paolo Nardi, MD, PhD, Cardiac Surgery Unit, Tor Vergata University Policlinic, Viale Oxford 81, 00133 Rome, Italy. Tel: +39 06 20903826; fax: +39 06 20903538; e-mail: pa.nardi4@libero.it

Received 20 March, 2015

Revised 9 June, 2015

Accepted 16 July, 2015

© 2016 Italian Federation of Cardiology. All rights reserved.