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Background  Cardiac disease after mediastinal radiotherapy for thoracic malignancy ( chest radiotherapy [XRT] ) often manifests as progressive aortic stenosis. In patients with  XRT ‐induced severe  aortic stenosis  undergoing surgical aortic valve replacement ( SAVR ), we sought to: (1) study long‐term survival and compare these patients with a matched cohort undergoing  SAVR  during the same time frame; and (2) identify potential predictors of long‐term mortality.    Methods and Results  We studied patients with symptomatic severe  aortic stenosis  undergoing  SAVR  at our institution, of which there were 172 mediastinal  XRT  patients (63±13 years, 62% women) matched in a 1:1 fashion (based on age, sex, time of surgery, and  aortic valve  area) with 172 non‐ XRT  patients (comparison group). Baseline clinical and postoperative data were obtained. Society of Thoracic Surgeons score was calculated and mortality was recorded. In the  XRT  group, the median  Society of Thoracic Surgeons  score was 4% (interquartile range 2–13), while mean left ventricular ejection fraction, left ventricular stroke volume index, and mean  aortic valve  gradient were 54±11%, 38±14 mL/m 2 , and 39±11 mm Hg, respectively. In the entire cohort, 27% and 34% of patients underwent concomitant coronary artery bypass grafting and aortic surgery at the time of  SAVR , respectively. Thirty‐day/in‐hospital deaths occurred in 4 (2%)  patients in the XRT  group and 0 patients in the comparison group. At 6±3 years of follow‐up, on matched group analysis, there were 95 (28%) deaths (83 [48%] in  the XRT  group versus 12 [7%] in the comparison group (log‐rank 89,  P <0.001). On multivariable Cox survival analysis, in the whole cohort, higher  Society of Thoracic Surgeons  score (hazard ratio, 1.14; 95% CI, 1.03–1.26) and mediastinal  XRT  ( hazard ratio,  8.12; 95% CI, 4.26–15.64) were associated with increased longer‐term mortality (both  P <0.01).    Conclusions  In patients with severe  aortic stenosis  undergoing  SAVR , patients with prior mediastinal  XRT  have significantly worse longer‐term survival versus a matched cohort.

journal of the american heart association

Long‐Term Outcomes of Patients With Mediastinal Radiation–Associated Severe Aortic Stenosis and Subsequent Surgical Aortic Valve Replacement: A Matched Cohort Study