Original Article
Cardiac Surgery in Patients with a History of Malignancy: Increased Complication Rate but Similar Mortality

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Background

Little is known about the outcome of cardiac surgery in patients with a prior history of malignancy. Our aim was to investigate in our unit the population of patients with a known malignancy and compare their outcomes to a matched population without malignancy.

Methods

We identified all patients who underwent cardiac surgery at the Alfred Hospital between February 2002 and December 2009 with malignancy. Cases were matched to 216 controls based on age, gender, major medical comorbidities and type of surgery. A univariate analysis was performed with Fishers exact test and χ2 test.

Results

83/4474 patients were identified with malignancy. Sixty-four (77%) were male. Mean age of the patients with malignancy was 66.7 years, and 67.4 in the control group. 68.7% had a solid organ tumour, and 31.3% had a haematological malignancy. There were no significant between-group differences in hospital or 30-day mortality. However, there were significantly higher rates of transfusion (79.5% vs 49%, p < 0.0001), reintubation (8.4% vs 0.9%, p = 0.0009), pneumonia (14.5% vs 6%, p = 0.035), septicaemia (8.4% vs 1.9%, p = 0.018), arrhythmias (42.2% vs. 33.8%, p = 0.047) and anticoagulant complications (7.2% vs 0%, p = 0.008) in patients with malignancies.

Conclusion

Patients who present for cardiac surgery having had prior treatment for cancer are at particular risk for complications. However, these patients can be operated upon with acceptable risk. There is no difference in the short term mortality. Therefore, for selected patients who are undergoing curative treatment for their malignancy, or are in remission, cardiac surgery is not contraindicated.

Introduction

Little is known about the outcome of cardiac surgery in patients with a prior history of malignancy. As the average age of the population undergoing heart surgery increases, the incidence of malignancies in this population will also increase. The decision to offer cardiac surgery to patients with a history of malignancy will be influenced by the likely effect of the malignancy or the surgical outcome. However, there is conflicting information about the risks of heart surgery in patients with a history of malignancy, with some groups reporting little difference in the outcome [1], [2], [3], and others showing a significant impact on morbidity [4] and survival [5], [6]. We therefore set out to assess the effect of malignancy on the outcome of cardiac surgery on our unit.

Section snippets

Patients and Methods

We identified all the patients who underwent cardiac surgery in our institution in the period from February 1, 2002 through December 31, 2009 with a known diagnosis of cancer. All patients in the review underwent their cardiac surgery with the use of cardiopulmonary bypass. Information about the patient's pre-operative status, procedure and early outcomes were obtained from the hospital cardiac surgery database which is linked to the Australasian Society of Cardiac and Thoracic Surgeons

Results

In the seven-year time period, from a total of 4474 operations performed, 83 patients with malignancy were identified (1.9%).

The comorbidities of the two groups were matched (Table 1), with the exception of dialysis, which was higher in the cancer group. In terms of surgery, the groups were matched with respect to surgical urgency and type (CABG vs. valvular). There was a trend towards slightly longer cross clamp time in the cancer group (83.7 min vs. 73.6 min, p = 0.08) and slightly longer

Discussion

With the ageing cardiac surgical population, it is not uncommon to have patients who have had previous malignancies referred for cardiac procedures. Approximately one patient per month is referred to our service for surgery that has had previous cancer. Our usual practice is to offer surgery only to patients who are in remission, however occasionally cardiac conditions requiring surgery are identified during pre-operative work up for a curative cancer procedure. These patients would have their

Conclusion

Patients who undergo cardiac surgery with a history of malignancy are at increased risk of in-hospital complications. Despite this, they are not at an increased risk of early mortality. Care must be exercised when assessing these patients preoperatively as well as perioperatively to reduce the incidence of avoidable complications. Cardiac surgery is not contraindicated for the treatment of heart disease in the patient with a history of malignancy.

Acknowledgments

The authors acknowledge Mr. Eldho Paul for his assistance in statistical analysis and Mr. Jim Duncan for maintaining the hospital cardiac surgery database. No external financial support was received.

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