The Effect of Chemotherapy on Development of Perioperative Cardiovascular Complications

Aleksandra Jukic*

Received: May 29, 2018;   Published: June 12, 2018

DOI: 10.26717/BJSTR.2018.05.001202

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Abstract

Introduction: Almost all chemotherapy agents in use so far have a demonstrated cardiotoxic effect. New therapy protocols have significantly improved long term prognosis of patients with malignant tumors and helped increase their life span, but it also caused the increase of incidence of onset of cardiotoxic effects. The aim of this study was to examine whether preoperatively administered chemotherapy agents influence the onset of perioperative cardiovascular complications and to examine the influence of certain factors on the onset of cardiotoxic effects.

Materials and Methods: Retrospective cohort study was conducted at the National cancer research center of Serbia. Data were collected from medical case histories and anesthesiology documentation of patients without previous cardiovascular disease operated at this institution from January 2013-December 2017. The first group consisted of 1283 patients who were previously administered chemotherapy agents with demonstrated cardiotoxic effect with no regard to the type of tumor, stage of the disease and the period elapsed between the administration of chemotherapy and operation. The second group consisted of 1626 patients who were not administered chemotherapy. Perioperative presence or absence of cardiovascular effects like hypotension, hypertension, arrhythmias, and ischemic changes, signs of heart failure or thromboembolism were followed.

Results: The incidence of onset of cardiotoxic effects in patients who were previously administered chemotherapy found in this study was 98.21%. Univariate regression analysis demonstrated significant correlation of intraoperative onset of cardiotoxic effects and previous administration of chemotherapy (RR=250.274; 95% CI=162.578 – 385.274; p<0.001) as well as previously administered radiotherapy (RR=170.753; 95% CI=54.702 – 533.005; p<0.001). Multivariate regression analysis demonstrated significant correlation of onset of cardiotoxic effects after administration of chemotherapy and the administration of radiotherapy (RR=190.506; 95% CI=120.118 – 302.141; p<0.001).

Conclusion: Patients who were previously administered chemotherapy have increased risk of developing perioperative cardiovascular complications. This requires thorough cardiac examination of these patients before the operation in order to better diagnose and treat consequences of cardiotoxic effects of chemotherapy.

Keywords: Cardiotoxicity; Chemotherapy; Anesthesia; Cancer

Abbreviations: ERE: ASA: American Society of Anesthesiology; EFLV: Ejection Fraction of Left Ventricle; DM: Diabetes Mellitus; SD: Standard Deviation

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