Cardiovascular surgical outcomes in patients with the antiphospholipid syndrome--a case-series.
BACKGROUND
Patients with the antiphospholipid syndrome (APLS) have severe involvement of the cardiovascular apparatus and often need surgical interventions to correct these manifestations. Few studies that have looked at the outcomes of cardiothoracic surgeries in APLS patients have reported high rates of perioperative mortality and thromboembolic events.


OBJECTIVE
Our goal was to examine the outcomes of adult APLS patients undergoing coronary artery bypass surgery (CABG) and/or valvular surgery. We also wanted to determine whether aggressive anticoagulation therapy could prevent life threatening thromboembolic complications in these patients.


METHODS
We retrospectively reviewed medical records of nine patients with primary APLS undergoing cardiothoracic surgery between 1985 and 2005 at our institution. Patient demographics, operative procedures and one-year clinical outcomes were obtained.


RESULTS
Forty-five percent of our patients had more than three cardiovascular risk factors other than APLS. There were no mortalities in our case series. However, 89% of our patients developed major complications. Despite aggressive anticoagulation, 37.5% developed thromboembolic events including cerebrovascular accidents, myocardial infarctions and vena caval thrombosis. Other complications included heparin-induced thrombocytopenia, redo of CABG surgery and sepsis.


CONCLUSIONS
Despite aggressive anticoagulation and lack of significant pre-operative co-morbidities, APLS patients undergoing cardiothoracic surgery appear to have high rates of post-operative clinical events.
Hegde
Vinayak Anant Padmanabh
VA
Department of Internal Medicine, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA. doctorvinayak@hotmail.com
Vivas
Yoel
Y
Shah
Hiren
H
Haybron
David
D
Srinivasan
Venkatraman
V
Dua
Ashish
A
Gradman
Alan
A
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000209:etiology / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants