SHOULD A PATIENT WITH A TREATED CANCER BE OFFERED AN OPEN-HEART OPERATION

The unknown but presumably reduced life expectancy of patients with ma lignant neoplasms may dissuade surgeons from performing necessary coro nary and valvular heart operations. There is also concern for recrudes cence of cancer as a result of an impaired immune system after cardiop ulmonary bypass. We analyzed the records of 2,190 patients who underwe nt cardiac operations requiring extracorporeal circulation between 198 8 and 1990. Of these, 46 patients had previously been treated for mali gnancy other than nonmelanoma skin cancer. Open heart operations were performed in patients with cardiac symptoms only in the absence of tum or recurrence. Tumor staging indicated reduced life expectancy in all patients. Thirty-eight patients (82.7%) had myocardial revascularizati on; 8 patients (17.3%) underwent valve operations. Postoperatively, al l but 2 patients were free from complications. In-hospital mortality w as 4.3% (2/46). One patient died of cardiogenic shock after combined a ortic and mitral valve replacement; the second patient succumbed to pu lmonary embolism after reoperative coronary artery bypass grafting. Ac tuarial survival at 3 years was 96% and all patients reported a satisf actory quality of life. This experience suggests that cardiac operatio ns in selected patients with previously treated cancer are safe and of fer clinical improvement at a reasonable operative risk.