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Eur J Cardiothorac Surg 2004;26:1059-1060
© 2004 Elsevier Science NL

Letter to the Editor

Cardiac surgery in patients with hematological disorders

Yuji Naito*, Masato Nakajima, Hidenori Inoue, Koji Tsuchiya

Department of Cardiovascular Surgery, Yamanashi Central Hospital, 1-1-1, Fujimi, Kofu-shi, Yamanashi, 400-0027, Japan

Received 14 August 2004; accepted 17 August 2004.

* Corresponding author. Tel.: +81 55 253 7111; fax: +81 55 253 8011. (E-mail: ujinaito{at}aol.com).

We appreciate the interest of Knobloch et al. in our article describing successful on-pump CABG in a patient with paroxysmal nocturnal hemoglobinuria (PNH) [1]. We read with great interest about the minute complement of the perioperative management against possible complications in on-pump cardiac surgery of PNH-patients in their report [2], and believed that it will serve as a useful reference to cardiac surgeons who encounter the PNH-patient with requisition of open-heart surgery.

As I mentioned in our report, several hematological disorders on cardiac surgery were treated successfully with respective treatment modalities against perioperative problems. Christiansen et al. [3] described about on-pump cardiac surgeries of nine patients with malignant hematological disorders, two patients with Hodgkin's lymphoma and one patient each with Waldenström's syndrome, multiple myeloma, polycythemia, myelodysplasia, chronic lymphocytic leukemia, non-Hodgkin's lymphoma and idiopathic aplastic anemia. Cardiac procedures performed were coronary artery bypass grafting in six, aortic valve replacement in two, and mitral valve replacement in one patient. As a whole, perioperative complications include:

1. Decreased number or impaired function of blood cells, which is aggravated by extracorporeal circulation In patients with myelodysplasia, chronic lymphocytic leukemia or idiopathic aplastic anemia and severe thrombocytopenia, substitution of various blood products is important to reduce the risk of bleeding complications.
2. Thrombosis caused by hyperviscosity syndrome in macroglobulinemia, polycythemia, and thrombocythemia In management against hyperviscosity syndrome, plasmapheresis may be useful in macrogloblinemia, as is bloodletting in patients with polycythemia. And it is recommended to choose a bioprosthesis in patients requiring valve replacement in order to avoid life-long anti-coagulation therapy.
3. Incremental risk for infections, caused by antibody deficiency syndromes, leukopenia, and an impaired T-cell-mediated immune response. Needless to say that it is great important to perform the surgery in aseptic condition, an adequate antimicrobial therapy should be taken. In certain patients with an antibody deficiency syndrome, treatment with immunoglobulins may help to reduce the risk of infection.

From the another point of view, if cardiac surgery is indicated in patients with a hematological disorder, we must assess that cardiac surgery is justified despite a considerable increased perioperative risk, and the patients benefit from cardiac surgery in the light of their life expectancy.

References

  1. Naito Y, Nakajima M, Inoue H, Tsuchiya K. Successful CABG in a patient with paroxysmal nocturnal hemoglobinuria. Eur J Cardiothorac Surg 2004;25:468-470.[Abstract/Free Full Text]
  2. Knobloch K, Zardo P, Gohrbandt B, Fischer S, Leyh RG, Tiede A, Ganser A, Schubert J. Cardiac surgery in a patient with paroxysmal nocturnal hemoglobinuria. Haematologica 2002;87:ECR29.[Medline]
  3. Christiansen S, Schmid C, Loher A, Scheld HH. Impact of malignant hematological disorders on cardiac surgery. Cardiovasc Surg 2000;8:149-152.[Medline]




This Article
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Right arrow Cardiac - pharmacology
Right arrow Cardiac - physiology
Right arrow Extracorporeal circulation
Right arrow Myocardial infarction

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