title: Outcomes of patients with antiphospholipid syndrome after pulmonary endarterectomy.
abstract: OBJECTIVE
  Antiphospholipid syndrome (APS) is a risk factor for chronic thromboembolic pulmonary hypertension, for which the treatment of choice is pulmonary endarterectomy. The increased risk of postoperative thrombotic complications in patients with APS may complicate the perioperative management. The primary objective of this study was to investigate the impact of APS on mortality and morbidity rates after pulmonary endarterectomy. The secondary objective was to describe platelet count changes after pulmonary endarterectomy in patients with APS.
  
  
  METHODS
  Data were collected prospectively for consecutive patients with APS who underwent pulmonary endarterectomy over a 5-year period [2007-2011] and for consecutive patients without APS who underwent pulmonary endarterectomy at the same centre during 2008-2011 [controls]. Major complications and daily platelet counts were collected. Haemodynamic parameters obtained by right heart catheterisation were recorded preoperatively and on the day after surgery.
  
  
  RESULTS
  We identified 17 patients with APS [3.6% of all pulmonary endarterectomies] and 190 controls. Early haemodynamic results after pulmonary endarterectomy were similar in the two groups, with a greater than 35% decrease in pulmonary vascular resistance. Significantly higher proportions of patients with APS than of controls experienced stroke [11.8 vs 1.0%, P= 0.03] and delirium [47 vs 20%; P = 0.02]. Compared with the controls, the patients with APS had significantly lower platelet counts and had a higher occurrence rate of platelet counts of ≤ 50 g/l (71 vs 4%; P < 0.0001). Intensive care unit (ICU) mortality was not significantly different between the two groups [0/17 vs 7/190 (3.7%), P = 0.49].
  
  
  CONCLUSIONS
  Neurological complications and severe thrombocytopenia were more common after pulmonary endarterectomy in patients with than without APS. Haemodynamic results and ICU mortality rate were similar in the two groups.
authors.affiliation: Cardiothoracic Intensive Care Unit, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Camous
authors.affiliation: Cardiothoracic Intensive Care Unit, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Decrombecque
authors.affiliation: Haemostasis Laboratory, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Louvain-Quintard
authors.affiliation: Haemostasis Laboratory, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Doubine
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Dartevelle
authors.affiliation: Cardiothoracic Intensive Care Unit, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France f.stephan@ccml.fr.
authors.forename: François
authors.initials: F
authors.lastname: Stéphan
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016022:Case-Control Studies; D003693:Delirium / Q000209:etiology; D004691:Endarterectomy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000601:surgery*; D020521:Stroke / Q000209:etiology; D013921:Thrombocytopenia / Q000209:etiology
keywords: Antiphospholipid syndrome; Mortality; Pulmonary endarterectomy; Stroke; Thrombocytopenia