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

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.

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.

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.

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.