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Ann Thorac Surg 2004;77:1593-1597
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Effect of prior malignancy on survival after cardiac surgery

Wilhelm P. Mistiaen, MD, PhDa*, Philip Van Cauwelaert, MDb, Philip Muylaert, MDb, Floris Wuyts, PhDc, Fernand Harrisson, PhDa, Hilde Bortier, MD, PhDa

a Laboratory for Anatomy, University of Antwerp, Antwerp, Belgium
b Department of Cardiovascular Surgery, General Hospital Middelheim, Antwerp, Belgium
c Medical Physics and Biometrics, University Hospital Antwerp, Edegem, Belgium

Accepted for publication August 28, 2003.

* Address reprint requests to Dr Mistiaen, Laboratory for Human Anatomy, University of Antwerp, Groenenborgerlaan 171, 2020 Antwerp, Belgium
e-mail: mistiaen{at}ruca.ua.ac.be

BACKGROUND: The number of patients with a previously treated tumor, needing cardiac surgery is increasing. Whether this operation in these patients is justified is determined by the long-term outcome.

METHODS: Of 8620 patients referred for cardiac surgery, 205 had a documented malignant tumor. The time interval between the occurrence of the tumor and the cardiac surgery was recorded. These patients were matched with 205 patients without a tumor according to age, gender, comorbidity and type of cardiac surgery. The patients were followed retrospectively. A {chi}2 Kaplan Meier and Cox' regression analysis were performed.

RESULTS: During follow-up, 95.8% of the patients were traced (2794 patient years). Univariate analysis showed that 5- and 10-year survival was better in patients without a malignant tumor in the history (0.91 ± 0.02 versus 0.72 ± 0.03 and 0.73 ± 0.04 versus 0.40 ± 0.05; p < 0.0001). For shorter time intervals, mortality for all causes and mortality due to the tumor increase significantly (p < 0.0001). Multivariate analysis identified 4 independent variables: a malignant tumor in the history (p < 0.001), chronic obstructive pulmonary disease (p = 0.003), age (p = 0.001), and impaired left ventricular function (p = 0.035)

CONCLUSIONS: A malignant tumor in the history is the most prognostic factor after cardiac surgery, but the operation is still rewarding. Fatal progression of the tumor is seen if the time interval between the occurrence of the malignant tumor and cardiac surgery is short. Other unfavorable factors are decreased left ventricular function, chronic obstructive pulmonary disease and high age.






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