Wilhelm P Mistiaen
University of Antwerp, Belgium
Wilhelm P. Mistiaen graduated as MD at the University of Antwerp in 1984. In 1994, he completed a surgical training and registered as surgeon. He completed his fi rst PhDin 1999 and a second one in 2009 at the same university. Currently, he is lecturer and associate professor of Anatomy and of Pathology at the University of Antwerp / Artesis-Plantijn University College.The focus of interest is complications after aortic valve replacement. Another focus is heart disease in patients with (prior) malignancy. Several manuscripts appeared on these topics. He is a regular reviewer for the European Journal of Cancer Prevention.
Cardiovascular disease and cancer are leading causes of mortality. Due to common risk factors, both conditionscan be present simultaneously or subsequently in one patient. A systematic literature search reveals that the presence of malignancy in cardiac patients series varies between 1.9 and 4.2%. In patients with simultaneous disease, the most threatening disease should be treated fi rst. Th is is usually the heart disease. If percutaneous coronary intervention is preferred, an antithrombotic treatment protocol has to be observed. Resulting bleeding and thrombotic tendencies have to be taken into account in the subsequent treatment of the malignancy.Using coronary artery bypass graft ing, combined or two-staged procedures are possible. A combinedoperation has the advantage of one admission and one anesthesia. It also avoids tumor progression during while waiting for a second operation in a staged procedure. Th irty-day mortality (between 4-7% in most series) and 5-year survival (up to 60%) aft er the combined procedure are comparable to results in patients without malignancy. Postoperative infection is problematic in patients with hematologic malignancies.In patients with heart disease aft er malignancy treated with curative intent,postoperative hospital mortality seems comparable to patients without prior malignancy. Five-year survival can be up to 80%, but the only existing large series with suffi ciently long-term follow-up indicates that the time interval between cancer treatment and cardiac surgery plays a dominant role: if this is below 2 years, 5-year mortality, especially due to metastasis, rises from 11 to 58%. In conclusion, aggressive treatment of both conditions in selected patients is worthwhile.