Management of radiation-induced valvular heart disease in the modern area

Abstract

Mediastinal irradiation for Hodgkin's lymphoma, may cause, years later, cardiac damages, termed “radiation-induced heart disease”. The objective of this study was to report the management of symptomatic radiation-induced valvular heart disease in the modern area with the development of transcatheter therapies. We retrospectively enrolled all patients who underwent a surgical or transcatheter procedure between January 2006 and January 2016 at our institution for a symptomatic radiation-induced valvular heart disease due to Hodgkin's lymphoma. Clinical preoperative characteristics, procedural data, immediate and mid-term outcomes were reported according to the procedure decided by the Heart Team. Thirty-seven patients (mean age 56 years, 70% men) were included: seventeen underwent a surgical valvular replacement, 16 a Transcatheter Aortic Valve Implantation (TAVI) and 4 a Transcatheter Mitral Valve Implantation (TMVI). In hospital and mid term outcomes are summarized in Table 1 . Surgery was mostly used in combined procedures ( P < 0.001). In-hospital mortality was 14%: 25% in surgical group, 6% in TAVI group and 0% in TMVI group ( P = 0.19). Twenty-two patients (59%) underwent some in-hospital complications, without significant difference between the 3 groups ( P = 0.44). In-hospital stay was lower in transcatheter groups (surgery: 14 days [10–17], TAVI: 7 days [5.5–14.5], TMVI: 6 days [5–12]). One-year mortality was 24%: 25% in surgical group, 18% in TAVI group and 50% in TMVI group ( P = 0.4). Cardiac outcome was acceptable in survivors. Survival curves are presented in Fig. 1 . Valvular replacement in radiation-induced valvular heart disease is associated with high rate of morbidity and mortality. Transcatheter interventions appeared a reasonable alternative to surgery, particularly in case of isolated valve disease although experience with TMVI was limited and require further validation.