[Coronary artery bypass grafting in a patient with systemic lupus erythematosus, scleroderma and secondary...

Area of Science:

• Cardiovascular Surgery
• Rheumatology
• Hematology

Background:

• Systemic lupus erythematosus (SLE), scleroderma, and secondary antiphospholipid syndrome (APS) are complex autoimmune conditions.
• Coronary artery bypass grafting (CABG) is a significant surgical intervention for ischemic heart disease.
• Antiphospholipid syndrome increases the risk of thrombotic events, particularly in the context of surgery.

Observation:

• A 71-year-old female patient with a history of SLE, scleroderma, and secondary APS presented with angina pectoris.
• The patient underwent successful coronary artery bypass grafting (CABG) utilizing cardiopulmonary bypass.
• Postoperative monitoring did not identify new thrombotic complications, such as neurological deficits.

Findings:

• Despite the patient's complex autoimmune and thrombotic risk profile, no overt postoperative thrombotic complications were recognized.
• The patient was discharged without any apparent immediate complications following CABG.
• This case highlights a potential discrepancy between high thrombotic risk and clinical presentation post-cardiac surgery.

Implications:

• Further investigation may be warranted to understand the factors contributing to the absence of recognized thrombotic events in this high-risk patient.
• This case may inform risk stratification and perioperative management strategies for patients with co-existing autoimmune diseases and antiphospholipid syndrome undergoing major cardiovascular surgery.
• Enhanced vigilance for subtle thrombotic manifestations in complex autoimmune patients post-cardiac surgery is crucial.