Thrombophilia in cardiac surgery-patients with symptomatic factor V Leiden.
OBJECTIVE
Thrombophilia may cause severe complications in cardiac surgical patients. We analyzed our experience with symptomatic factor V Leiden patients.


METHODS
Over an eight-year period, 14 symptomatic patients previously diagnosed with activated protein C resistance,caused by factor V Leiden, underwent a cardiac surgical procedure. We retrospectively reviewed the clinical data, operative and postoperative courses, and the intermediate-term results of these patients.


RESULTS
Procedures performed were coronary artery bypass grafting (CABG, 10 patients), aortic valve replacement+ CABG, pulmonary thromboendarterectomy, left ventricular thrombus removal, and aortic valve reconstruction(one patient each). Eleven patients survived; three patients died perioperatively, one from sepsis (25 days after surgery), one from recurrent stroke (28 days after surgery), and one from multiorgan failure following perioperative stroke (31 days after surgery). In one patient, all bypass grafts occluded intraoperatively.Three patients underwent cardiac surgery under continuous anticoagulation with phenprocoumon. In these three patients, no perioperative thromboembolic events occurred. At a mean follow-up of 32 months,three patients had suffered from cerebral stroke, two from graft occlusion, of which one was recurrent. Two more patients had died (one after cerebral stroke and one from cerebral metastases of a renal cell carcinoma).


CONCLUSIONS
In 14 patients with symptomatic factor V Leiden who underwent cardiac surgery, we observed a considerable number of fatal and nonfatal thromboembolic events in the perioperative period and during a 32 months' follow-up. As conducted in three patients, continued anticoagulation with coumarin was safe and prevented perioperative thromboembolic events.
Massoudy
Parwis
P
Department for Thoracic and Cardiovascular Surgery, West German Heart Center Essen, Hufelandstrasse 55, Essen, Germany. parwis.massoudy@uk-essen.de
Thielmann
Matthias
M
Müller-Beissenhirtz
Hannes
H
Görlinger
Klaus
K
Dietrich
Wulf
W
Herget-Rosenthal
Stefan
S
Jakob
Heinz
H
D020016:Activated Protein C Resistance / Q000235:genetics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013504:Cardiovascular Surgical Procedures; D005165:Factor V / Q000235:genetics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017354:Point Mutation; D011183:Postoperative Complications; D012189:Retrospective Studies; D013923:Thromboembolism / Q000209:etiology*
C095381:factor V Leiden; D005165:Factor V