Cardiac surgery for radiation-induced heart disease: a comprehensive assessment of perioperative period with personalized analysis of morphological data

Radiotherapy (RT) in combined treatment of mediastinal malignancies currently allows for stable remission. Despite improvements in RT techniques aimed at minimizing total focal dose, ionizing radiation still leads to post-radiation cardiac injury (PRCI) with progressive chronic heart failure (CHF) resistant to standard drug therapy. Cardiac surgery is one of the treatment options for consequences of PRCI. Previous RT for mediastinal malignancies predicts worse short- and long-term postoperative outcomes. Complex radiation-induced damage to all cardiac structures (pericardium, myocardium, coronary arteries, valves and conduction system), severe calcification of ascending aorta and pulmonary fibrosis significantly complicate technical aspects of surgery, increase surgery time and risk of intra- and postoperative complications. Obviously, a detailed analysis of pathophysiological mechanisms of PRCI underlies a personalized approach to the treatment of appropriate patients. Clinical and morphological data will facilitate objective risk stratification, creation of an optimized pharmacological strategy, analysis of timing and extent of cardiac surgery aimed at reducing risks and improving long-term prognosis in these patients.