title: Increased morbidity and mortality in patients with antiphospholipid syndrome undergoing valve replacement surgery.
abstract: OBJECTIVE
  Heart valve abnormalities are commonly found in patients with antiphospholipid syndrome but experience with valve replacement in such patients is limited. We analyzed the results of valve replacement in patients with this condition at our institution.
  
  
  METHODS
  Between 1989 and 2002, 10 patients with antiphospholipid syndrome (8 women, 2 men; aged 38-73 years, mean 49 years) with severe mitral valve disease (n = 7), aortic valve disease (n = 2), or combined mitral-aortic disease (n = 1) underwent valve replacement. We reviewed retrospectively their clinical data, operative and postoperative courses, and the long-term results. Pathological reassessment was performed in all cases.
  
  
  RESULTS
  Procedures performed included mitral valve replacement in 7 patients, aortic valve replacement in 2 patients, and combined aortic valve replacement plus mitral valve replacement in 1 patient. In addition, 2 patients underwent tricuspid annuloplasty. The immediate mortality was 20% (2 patients). Major complications occurred in 2 other cases. During a follow-up period of up to 8 years, 2 patients required repeat operation for valve-related complications (1 death). An additional patient died of cardiac causes 13 months after surgery. One patient had major thromboembolic events 3 and 10 months after the operation. The late outcome was uneventful in only 4 patients.
  
  
  CONCLUSIONS
  Valve replacement in patients with antiphospholipid syndrome may carry significant early and late mortality and morbidity, particularly when such patients are referred with advanced valvular heart disease.
authors.affiliation: Department of Pediatrics, Bikur Cholim Hospital, Jerusalem, Israel.
authors.forename: Yackov
authors.initials: Y
authors.lastname: Berkun
authors.forename: Amir
authors.initials: A
authors.lastname: Elami
authors.forename: Karen
authors.initials: K
authors.lastname: Meir
authors.forename: Dror
authors.initials: D
authors.lastname: Mevorach
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Naparstek
mesh_terms: D000328:Adult; D000368:Aged; D016736:Antiphospholipid Syndrome / Q000453:epidemiology* / Q000601:surgery*; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D009017:Morbidity; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome