title: Cardiac surgery and hematologic malignancies: a retrospective single-center analysis of 56 consecutive patients.
abstract: OBJECTIVE
  Patients with a history of hematologic malignancies (HMs) are considered high-risk candidates for cardiac surgery. Increased perioperative rates of infections, thrombo-embolic complications, and bleeding disorders are reported. However, low patient numbers and lack of control groups limit all published studies.
  
  
  METHODS
  A total of 56 patients with a history of HM underwent cardiac surgery. As many as 29 patients suffered from non-Hodgkin lymphoma, five from Hodgkin disease, and 12 from myeloproliferative disorders, one from acute lymphatic leukemia, and nine from monoclonal gammopathy. Surgery consisted of coronary artery bypass grafting, valvular surgery or combination procedures. HM patients were matched to 142 controls. Matching criteria applied consisted of sex, age, main diagnosis, and co-morbidities.
  
  
  RESULTS
  In-hospital mortality was elevated in HM patients though not reaching significance (P = 0.7). HM patients demonstrated increased rates of vascular, pulmonary, infectious complications (P > 0.1), and transfusion requirements (P = 0.077). The long-term survival of HM patients was significantly impaired (P = 0.043). A history of irradiation or chemotherapy predisposed to postoperative respiratory insufficiency, acute renal failure, and an impaired long-term survival (P > 0.065).
  
  
  CONCLUSIONS
  Cardiac surgery in patients with a history of a malignant hematologic disorder might achieve acceptable results. However, a higher complication and mortality rate have to be anticipated. Patients with hematologic disorders and a history of either irradiation or chemotherapy appear to be at an increased risk to develop postoperative end-organ failure.
authors.affiliation: Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany. sommer_s1@klinik.uni-wuerzburg.de
authors.forename: Sebastian-Patrick
authors.initials: SP
authors.lastname: Sommer
authors.forename: Volkmar
authors.initials: V
authors.lastname: Lange
authors.forename: Cagatay
authors.initials: C
authors.lastname: Yildirim
authors.forename: Christoph
authors.initials: C
authors.lastname: Schimmer
authors.forename: Ivan
authors.initials: I
authors.lastname: Aleksic
authors.forename: Christoph
authors.initials: C
authors.lastname: Wagner
authors.forename: Christoph
authors.initials: C
authors.lastname: Schuster
authors.forename: Rainer G
authors.initials: RG
authors.lastname: Leyh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004812:Epidemiologic Methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013530:Surgical Wound Infection / Q000209:etiology