title: Cardiac valve replacement in patients with antiphospholipid syndrome.
abstract: OBJECTIVE
  To analyze the results of cardiac valve replacement in a multicenter cohort of patients with antiphospholipid syndrome (APS) and to identify prognostic factors of poor outcome.
  
  
  METHODS
  We performed a retrospective analysis of clinical manifestations (cardiac involvement and APS characteristics), operative and early postoperative courses, and long-term followup. All of the patients fulfilled the Sapporo criteria for APS. Logistic regression analyses were performed to identify those variables associated with adverse outcomes.
  
  
  RESULTS
  Between 1981 and 2008, 33 valvular replacements were carried out in 32 patients with APS. The mean ± SD age at the time of surgery was 43.09 ± 14.08 years. Thirty patients were women. Primary APS was present in 21 patients. The median followup time after surgery was 33.5 months (range 0-192 months). The mitral valve was the most frequently replaced (22 of 33). Mechanical valve replacement was performed in 23 patients (71.9%). The mortality rate was 12.5% (1 cardiogenic shock, 1 septic shock, 1 following renal transplantation, and 1 hemorrhagic stroke). Fourteen patients experienced 20 complications (8 major bleeding, 5 thrombotic events, 2 valvular deteriorations, 2 third-degree atrioventricular block, 1 endocarditis, 1 cardiac tamponade, and 1 cardiac failure). Fifty percent of the patients had an uneventful outcome.
  
  
  CONCLUSIONS
  Morbidity and mortality were high in APS patients undergoing valve replacement surgery. Most complications were related to thrombosis and bleeding. Anticoagulation must be carefully monitored to prevent hemorrhagic and thrombotic complications.
authors.affiliation: Hospital Universitario Cruces, Barakaldo, Spain. jgerdocas@yahoo.es
authors.forename: José-Gabriel
authors.initials: JG
authors.lastname: Erdozain
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Irastorza
authors.forename: Maria-Isabel
authors.initials: MI
authors.lastname: Segura
authors.forename: Mary-Carmen
authors.initials: MC
authors.lastname: Amigo
authors.forename: Gerard
authors.initials: G
authors.lastname: Espinosa
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: Pomar
authors.forename: Ignacio
authors.initials: I
authors.lastname: Perez-Valero
authors.forename: Oier
authors.initials: O
authors.lastname: Ateka-Barrutia
authors.forename: Munther A
authors.initials: MA
authors.lastname: Khamashta
mesh_terms: D000328:Adult; D000368:Aged; D016736:Antiphospholipid Syndrome / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies