Cardiac operations in patients with hematologic malignancies.
OBJECTIVE
Patients with hematologic malignancies are frequently in need of major cardiac operations. Previous reports suggest an increased risk for perioperative complications in these immunodeficient patients.


METHODS
Patients diagnosed with any type of hematologic malignancy who underwent open-heart surgery at our institution between 7/1996 and 6/2002 were identified. Their hospital charts were reviewed; demographics, perioperative data and outcomes were recorded.


RESULTS
There were 24 patients (20 men, 4 women); mean age was 68+/-13 years (range 31-84 years). Ten patients had chronic lymphocytic leukemia, seven non-Hodgkin lymphomas, three multiple myeloma and one Hodgkin's disease, chronic myelocytic leukemia, hairy cell leukemia and cutaneous T-cell lymphoma each. The mean pre-operative duration of the hematologic disease was 6.6 years. Twenty-two patients underwent coronary artery bypass grafting (with valve replacement in three patients) and two patients had isolated valve replacement. There was one in-hospital death (4.1%). Twelve patients (50%) had a minor or major complication. Seven reoperations were required-five during the same admission (one for mediastinal bleeding, one for an expanding femoral pseudoaneurysm, one for acute cholecystitis and two for IACD/pacer insertion) and two within 30 days (one for deep sternal wound infection and one for leg wound infection). Mean post-operative stay was 8.2+/-5.8 days and mean ICU stay was 1.6+/-1.1 days. There were three late deaths-two were due to progression of the hematologic disease. The 3-year actuarial survival was 83%.


CONCLUSIONS
Cardiac operations can be performed with acceptable mortality but significant morbidity rates in patients with hematologic malignancies. Bleeding and infectious complications are most frequently seen and usually lead to reoperations. These findings warrant caution during patient selection.
Fecher
Alison M
AM
Department of Surgery, Temple University School of Medicine Clinical Campus at the Western Pennsylvania Hospital, 4800 Friendship Ave, Pittsburgh, PA 15224, USA. afecher@wpahs.org
Birdas
Thomas J
TJ
Haybron
David
D
Papasavas
Pavlos K
PK
Evers
Debbie
D
Caushaj
Philip F
PF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection; D016019:Survival Analysis