CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 4, May 2012
194
AFRICA
Can cardiac surgery be performed safely on patients
with haematological malignancies
A GULER, MA SAHIN, F CINGOZ, E OZAL, U DEMIRKILIC, M ARSLAN
Abstract
Introduction:
Surgical strategy in patients with haematologi-
cal malignancies must be planned and carried out with the
specific aim of decreasing postoperative complications. The
aim of this study was to present our experience on patients
previously diagnosed with haematological malignancies who
subsequently underwent cardiac surgery. We include data to
assist other surgeons predict factors affecting postoperative
morbidity and mortality in this group of patients.
Methods:
Fifteen patients diagnosed with haematological
malignancies who had cardiac surgery were retrospectively
analysed. Eight patients had chronic lymphocytic leukaemia,
six had non-Hodgkin’s lymphoma and the rest had chronic
myelocytic leukaemia. Coronary artery bypass graft surgery
was performed on all of them.
Results:
There were no hospital mortalities. The average
follow-up period was 35
±
11 (23–56) months. Three patients
required early postoperative re-operation because of exces-
sive bleeding. No mortalities were seen in the early post-
operative period. There were five (33%) deaths during the
late follow-up period. Three patients were lost due to intrac-
ranial bleeding (confirmed by autopsy) in the 16th, 23rd
and 38th months after surgery. The remaining two patients
had sudden death in the eighth and 55th months from non-
detectable causes.
Conclusion:
Cardiac surgery can be performed with accept-
able early postoperative outcomes in patients with haemato-
logical malignancies. Intracranial bleeding is an important
factor contributing to late mortality and patient selection
and risk stratification are crucial to improving surgical
benefits.
Keywords:
haematological malignancy, cardiac surgery,
intracranial bleeding
Submitted 4/9/10, accepted 6/9/11
Cardiovasc J Afr
2012;
23
: 194–196
DOI: 10.5830/CVJA-2011-053
Increased surgical experience and technological advances in
cardiac surgery have encouraged surgeons to perform complex
cardiac operations in patients with unrelated complications.
Several procedures are performed nowadays on patients with
co-morbidity factors, with acceptable morbidity and mortality
rates.
1
Haematological malignancies are diagnosed in all age
groups but the chronic forms are predominantly seen in elderly
populations.
2
Great strides have been made to improve the
quality of life of these patients and many clinicians are now
focusing on finding solutions to other symptoms these patients
may have. In an era when atherosclerotic heart disease shows an
increasing prevalence, cardiac surgeons are encountering this
population more frequently.
The operative risk of patients with malignant haematological
disorders is increased, as this may include coagulation defects,
changes in blood viscosity, immune suppression and bone marrow
insufficiency.
3
When surgically treating these patients, one must
be concerned about postoperative infection, haemorrhage and
leukaemic transformation. Surgical trauma and cardiopulmonary
bypass (CPB), because of their immune-depressing effects, have
the potential risk of increasing the haematological problems,
leading to fatal or morbid complications.
4
There are few reports on how to deal with these patients, and
also little knowledge on their progress after cardiac surgery. Due
to these concerns, the aim of our study was to detail our clinical
experience and data on the postoperative period.
Methods
We retrospectively reviewed hospital records of 15 patients with
haematological malignancies who underwent cardiac surgery
at the Cardiovascular Surgery Department of our institution
between 2003 and 2009. Eight patients suffered from chronic
lymphocytic leukemia (CLL), six had non-Hodgkin’s lymphoma
(NHL), and the rest had chronic myelocytic leukaemia. Coronary
artery bypass graft (CABG) surgery was performed on all
patients.
The diagnosis of haematological malignancy was assigned
based on the international ICD-10 code. Patients received
routine intravenous antibiotic prophylaxis (cephazolin Na 1 g)
for three days, beginning the night before surgery. CPB was
performed after the standard heparinisation (ACT
>
400 s). All
the patients were given antegrade cold crystalloid cardioplegia
with moderate hypothermia, and topical cold slush solution was
used.
The left internal mammary artery (LIMA) and saphenous
vein grafts were prepared for CABG surgery. Distal anastomoses
were performed with 7/0 polypropylene sutures and a continuous
suture technique. Proximal anastomoses were performed with
6/0 polypropylene sutures and a continuous suture technique
with a side clamp. Salicylic acid 100 mg was started on the first
postoperative day in all patients.
Patients’ hospital charts, demographics, peri-operative data
and complications were reviewed. Follow-up data were obtained
by review of subsequent hospital admissions and telephone
Department of Cardiovascular Surgery, Gulhane Military
Medical Academy, Etlik, Ankara, Turkey
A GULER, MD
MA SAHIN, MD,
F CINGOZ, MD
E OZAL, MD
U DEMIRKILIC, MD
M ARSLAN, MD
