title: Cardiac surgery in cases of myeloproliferative neoplasm: risk factor for stroke.
abstract: OBJECTIVE
  a history of myeloproliferative neoplasms is considered to increase the risks in cardiac surgery. In patients with myeloproliferative neoplasms, increased rates of perioperative infections and thromboembolic complications are suspected, but studies analyzing the impact of myeloproliferative neoplasms on results after cardiac surgery are lacking.
  
  
  METHODS
  13 patients with the diagnosis of myeloproliferative neoplasm underwent cardiac surgery. These patients were matched to 36 controls. Matching criteria consisted of sex, age, diagnosis, and comorbidities. Patients were analyzed regarding laboratory parameters, blood transfusion demands, morbidity, and mortality.
  
  
  RESULTS
  compared to controls, patients with myeloproliferative neoplasms demonstrated a significantly lower body-mass index (p<0.01), creatinine (p=0.024), prothrombin time (p=0.001), and urea level (p=0.012). The perioperative leukocyte response (p=0.03) was ameliorated, and platelet counts (p<0.02) increased. Patients with myeloproliferative neoplasms had a reduced need for erythrocyte concentrates (54% vs. 86%, p=0.047) but increased need for plasma and thrombocytes (15% vs. 0%, p=0.07). Patients with myeloproliferative neoplasms had a significantly increased incidence of thromboembolic events compared to controls (31% vs. 3%, p=0.014). Hospital mortality remained at zero, but mid-term survival was lower in patients with myeloproliferative neoplasms (p=0.078).
  
  
  CONCLUSIONS
  myeloproliferative neoplasm as a concomitant diagnosis increases the risk of thromboembolic complications during cardiac surgery. Plasma and platelet substitutions have to be administered, although strokes were not associated with hemostatic treatment.
authors.affiliation: Cardiothoracic and Thoracic Vascular Surgery, University Hospital Wu¨rzburg, Oberdu¨rrbacher Strasse 6, 97080 Wu¨rzburg, Germany. sommer_s1@klinik.uni-wuerzburg.de
authors.forename: Sebastian-Patrick
authors.initials: SP
authors.lastname: Sommer
authors.forename: Christoph
authors.initials: C
authors.lastname: Wagner
authors.forename: Stefanie
authors.initials: S
authors.lastname: Sommer
authors.forename: Jens-Holger
authors.initials: JH
authors.lastname: Krannich
authors.forename: Ivan
authors.initials: I
authors.lastname: Aleksic
authors.forename: Christoph
authors.initials: C
authors.lastname: Schimmer
authors.forename: Christoph
authors.initials: C
authors.lastname: Schuster
authors.forename: Rainer G
authors.initials: RG
authors.lastname: Leyh
mesh_terms: D000368:Aged; D019046:Bone Marrow Neoplasms / Q000150:complications*; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009196:Myeloproliferative Disorders / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*