Long-term outcomes of mitral valve surgery after mediastinal radiation therapy (MRT) are not well characterized. We analyzed long-term survival in patients who underwent mitral valve repair or replacement after MRT. From 2001 to 2018, 148 patients underwent mitral valve surgery at our institution after MRT for cancer. The association between surgery group and survival was assessed using Cox proportional hazards modeling, with propensity score adjustment to control for clinical and operative differences between groups. Mitral valve was repaired in 48 (32.4%) and replaced in 100 (67.6%) patients. The groups (repair vs replacement) were similar in age (62.0 vs 57.1 years, p = 0.10), gender (female n = 38, 79.2% vs n = 65, 65%, p = 0.08), chronic lung disease (n = 12, 25.0% vs n = 37, 37.0%, p = 0.19), congestive heart failure (n = 13, 27.1% vs n = 38, 38.4%, p = 0.20), but differed in atrial fibrillation (n = 17, 35.4% vs n = 13, 13.0%, p = 0.002), first cardiovascular surgery (n = 34, 70.8% vs n = 47, 47.0%, p = 0.006), and time since MRT (median 12, 7–27 years, vs 30, 19–37 years, p < 0.001). Long term survival was no different between groups in the unadjusted (p = 0.835) and propensity-adjusted (p = 0.645) analysis, and inferior to the expected survival of an age- and sex-matched population. Mediastinal irradiation negatively impacts survival in patients who undergo mitral valve surgery. The traditional advantage of mitral valve repair over replacement on long-term survival was not seen in patients with radiation associated mitral valve disease.

纵隔放射治疗 (MRT) 后二尖瓣手术的长期结果尚未得到很好的表征。我们分析了在 MRT 后接受二尖瓣修复或置换术的患者的长期生存率。从 2001 年到 2018 年，148 名患者在 MRT 治疗癌症后在我们机构接受了二尖瓣手术。使用 Cox 比例风险模型评估手术组与生存率之间的关联，并调整倾向评分以控制组间的临床和手术差异。二尖瓣在 48 名 (32.4%) 患者中进行了修复，在 100 名 (67.6%) 患者中进行了更换。各组（修复与更换）在年龄（62.0 与 57.1 岁，p = 0.10）、性别（女性 n = 38、79.2% 与 n = 65、65%，p = 0.08）、慢性肺病（n = 12, 25.0% 对比 n = 37, 37.0%, p = 0.19),充血性心力衰竭（n = 13, 27.1% vs n = 38, 38.4%, p = 0.20），但房颤不同（n = 17, 35.4% vs n = 13, 13.0%, p = 0.002），第一心血管手术（n = 34、70.8% vs n = 47、47.0%，p = 0.006）和自 MRT 以来的时间（中位数 12、7-27 年与 30、19-37 年，p < 0.001）。在未调整的 (p = 0.835) 和倾向调整的 (p = 0.645) 分析中，各组之间的长期生存率没有差异，并且低于年龄和性别匹配人群的预期生存率。纵隔照射对接受二尖瓣手术的患者的生存有负面影响。与放射相关二尖瓣疾病患者相比，二尖瓣修复相对于置换术在长期生存方面的传统优势并未出现。