Should a patient with a treated cancer be offered an open heart operation?

Abstract

The unknown but presumably reduced life expectancy of patients with malignant neoplasms may dissuade surgeons from performing necessary coronary and valvular heart operations. There is also concern for recrudescence of cancer as a result of an impaired immune system after cardiopulmonary bypass. We analyzed the records of 2,190 patients who underwent cardiac operations requiring extracorporeal circulation between 1988 and 1990. Of these, 46 patients had previously been treated for malignancy other than nonmelanoma skin cancer. Open heart operations were performed in patients with cardiac symptoms only in the absence of tumor recurrence. Tumor staging indicated reduced life expectancy in all patients. Thirty-eight patients (82.7%) had myocardial revascularization; 8 patients (17.3%) underwent valve operations. Postoperatively, all but 2 patients were free from complications. In-hospital mortality was 4.3% (2/46). One patient died of cardiogenic shock after combined aortic and mitral valve replacement; the second patient succumbed to pulmonary embolism after reoperative coronary artery bypass grafting. Actuarial survival at 3 years was 96%, and all patients reported a satisfactory quality of life. This experience suggests that cardiac operations in selected patients with previously treated cancer are safe and offer clinical improvement at a reasonable operative risk.