I’ve Had Radiation: Will Heart Surgery Be Risky for Me?

A cardiologist supplies The Short Answer

I’ve Had Radiation. Will Heart Surgery Be Risky for Me?

Q: I’ve had radiation therapy to the chest. Will heart surgery be riskier for me?

A: Radiation therapy to the chest to treat cancer — most often breast cancer or Hodgkin’s lymphoma — can lead to what’s known as radiation heart disease.

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This condition may develop in cancer survivors 10 or more years after their radiation therapy, and it may take the form of coronary artery disease, heart valve disease, disease of the sac around the heart, or damage to the heart muscle. Affected patients tend to be younger than heart disease patients overall.

Many patients with radiation heart disease eventually need cardiac surgery to manage it. Research has shown that these patients with radiation heart disease fare less well than other cardiac surgery patients. In fact, they are about 2.5 times more likely to die within seven years after their cardiac surgery compared with cardiac surgery patients overall. The difference in survival does not appear right after surgery but increases over time.

The good news is that radiation oncologists have improved their techniques in recent years with smaller and better-targeted radiation doses, reducing the damaging effects of chest radiation on cancer patients’ hearts.

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But patients who received chest radiation years ago can’t count on this benefit. So if you have heart disease and received radiation therapy in the past, make sure your heart doctors are aware of that. This knowledge might influence how they decide to treat your heart disease, perhaps leading them to consider surgery at an earlier stage of disease or to give more weight to alternatives to surgery. The result may improve your long-term prognosis.

— Cardiologist Brian Griffin, MD

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