Cardiac operations in patients with hematologic malignancies

Alison M. Fecher, Thomas Birdas, David Haybron, Pavlos K. Papasavas, Debbie Evers, Philip F. Caushaj

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objectives: Patients with hematologic malignancies are frequently in need of major cardiac operations. Previous reports suggest an increased risk for perioperative complications in these immunodeficient patients. Methods: Patients diagnosed with any type of hematologic malignancy who underwent open-heart surgery at our institution between 7/1996 and 6/2002 were identified. Their hospital charts were reviewed; demographics, perioperative data and outcomes were recorded. Results: There were 24 patients (20 men, 4 women); mean age was 68±13 years (range 31-84 years). Ten patients had chronic lymphocytic leukemia, seven non-Hodgkin lymphomas, three multiple myeloma and one Hodgkin's disease, chronic myelocytic leukemia, hairy cell leukemia and cutaneous T-cell lymphoma each. The mean pre-operative duration of the hematologic disease was 6.6 years. Twenty-two patients underwent coronary artery bypass grafting (with valve replacement in three patients) and two patients had isolated valve replacement. There was one in-hospital death (4.1%). Twelve patients (50%) had a minor or major complication. Seven reoperations were required - five during the same admission (one for mediastinal bleeding, one for an expanding femoral pseudoaneurysm, one for acute cholecystitis and two for IACD/pacer insertion) and two within 30 days (one for deep sternal wound infection and one for leg wound infection). Mean post-operative stay was 8.2±5.8 days and mean ICU stay was 1.6±1.1 days. There were three late deaths - two were due to progression of the hematologic disease. The 3-year actuarial survival was 83%. Conclusions: Cardiac operations can be performed with acceptable mortality but significant morbidity rates in patients with hematologic malignancies. Bleeding and infectious complications are most frequently seen and usually lead to reoperations. These findings warrant caution during patient selection.

Original languageEnglish (US)
Pages (from-to)537-540
Number of pages4
JournalEuropean Journal of Cardio-thoracic Surgery
Volume25
Issue number4
DOIs
StatePublished - Apr 2004
Externally publishedYes

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Hematologic Neoplasms
Hematologic Diseases
Wound Infection
Reoperation
Hemorrhage
Hairy Cell Leukemia
Cutaneous T-Cell Lymphoma
Acute Cholecystitis
False Aneurysm
B-Cell Chronic Lymphocytic Leukemia
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Thigh
Multiple Myeloma
Hodgkin Disease
Coronary Artery Bypass
Non-Hodgkin's Lymphoma
Patient Selection
Thoracic Surgery
Leg
Demography

Keywords

  • Cardiac
  • Complications
  • Coronary artery disease
  • Hematologic
  • Leukemia
  • Lymphoma
  • Malignancies
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Cardiac operations in patients with hematologic malignancies. / Fecher, Alison M.; Birdas, Thomas; Haybron, David; Papasavas, Pavlos K.; Evers, Debbie; Caushaj, Philip F.

In: European Journal of Cardio-thoracic Surgery, Vol. 25, No. 4, 04.2004, p. 537-540.

Research output: Contribution to journalArticle

Fecher, Alison M. ; Birdas, Thomas ; Haybron, David ; Papasavas, Pavlos K. ; Evers, Debbie ; Caushaj, Philip F. / Cardiac operations in patients with hematologic malignancies. In: European Journal of Cardio-thoracic Surgery. 2004 ; Vol. 25, No. 4. pp. 537-540.
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AU - Fecher, Alison M.

AU - Birdas, Thomas

AU - Haybron, David

AU - Papasavas, Pavlos K.

AU - Evers, Debbie

AU - Caushaj, Philip F.

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AB - Objectives: Patients with hematologic malignancies are frequently in need of major cardiac operations. Previous reports suggest an increased risk for perioperative complications in these immunodeficient patients. Methods: Patients diagnosed with any type of hematologic malignancy who underwent open-heart surgery at our institution between 7/1996 and 6/2002 were identified. Their hospital charts were reviewed; demographics, perioperative data and outcomes were recorded. Results: There were 24 patients (20 men, 4 women); mean age was 68±13 years (range 31-84 years). Ten patients had chronic lymphocytic leukemia, seven non-Hodgkin lymphomas, three multiple myeloma and one Hodgkin's disease, chronic myelocytic leukemia, hairy cell leukemia and cutaneous T-cell lymphoma each. The mean pre-operative duration of the hematologic disease was 6.6 years. Twenty-two patients underwent coronary artery bypass grafting (with valve replacement in three patients) and two patients had isolated valve replacement. There was one in-hospital death (4.1%). Twelve patients (50%) had a minor or major complication. Seven reoperations were required - five during the same admission (one for mediastinal bleeding, one for an expanding femoral pseudoaneurysm, one for acute cholecystitis and two for IACD/pacer insertion) and two within 30 days (one for deep sternal wound infection and one for leg wound infection). Mean post-operative stay was 8.2±5.8 days and mean ICU stay was 1.6±1.1 days. There were three late deaths - two were due to progression of the hematologic disease. The 3-year actuarial survival was 83%. Conclusions: Cardiac operations can be performed with acceptable mortality but significant morbidity rates in patients with hematologic malignancies. Bleeding and infectious complications are most frequently seen and usually lead to reoperations. These findings warrant caution during patient selection.

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KW - Leukemia

KW - Lymphoma

KW - Malignancies

KW - Surgery

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