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Cardiac surgery in systemic lupus erythematosus patients: Clinical characteristics and outcomes
Javier Tejeda-Maldonado1, Lauro Quintanilla-González1, Jaime Galindo-Uribe2
1Departamento de Medicina Interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
Insights
Cardiac surgery in patients with systemic lupus erythematosus (SLE) leads to high rates of complications and death. Identifying preoperative risk factors is crucial for improving outcomes in these complex cases.
Area of Science:
- Cardiology
- Rheumatology
- Surgical Outcomes
Background:
- Systemic lupus erythematosus (SLE) is a complex autoimmune disease that can affect multiple organ systems, including the cardiovascular system.
- Cardiac surgery in SLE patients presents unique challenges due to the inflammatory nature of the disease and potential comorbidities.
- Understanding the specific risks and outcomes associated with cardiac surgery in this population is essential for patient management.
Purpose of the Study:
- To investigate the clinical characteristics and postoperative outcomes of patients with systemic lupus erythematosus (SLE) undergoing cardiac surgery.
- To identify factors associated with complications, mortality, and long-term survival in SLE patients after cardiac procedures.
Main Methods:
- A retrospective analysis was conducted on 30 SLE patients who underwent cardiac surgery at a single institution.
- Data collected included demographics, comorbidities, SLE-specific characteristics, cardiovascular risk scores, surgical procedures, and postoperative events.
- Statistical analysis was performed to identify predictors of complications and mortality.
Main Results:
- The most common procedures were valve replacement (53%) and pericardial window (37%).
- Postoperative complications occurred in 63% of patients, primarily infections. Aortic cross-clamp time ≥76 minutes was linked to complications (OR 6.4).
- Early and late mortality rates were 17% and 10%, respectively, mainly due to sepsis and heart failure. Factors like disease activity, lymphopenia, younger age, and NYHA class III were associated with adverse outcomes.
Conclusions:
- Cardiac surgery in SLE patients is associated with significant morbidity and mortality.
- The study highlights the need for developing SLE-specific preoperative risk scores to better identify patients at higher risk.
- Further research is warranted to optimize perioperative management and improve outcomes for this vulnerable patient group.
Objectives:
To study the clinical characteristics and outcomes in systemic lupus erythematosus (SLE) patients who underwent cardiac surgery.
Methods:
Retrospective analysis of 30 SLE patients who underwent cardiac surgery at a single center. Demographics, comorbidities, clinical and serologic characteristics, cardiovascular risk scores and treatment were recorded. Type of surgery, postoperative complications, mortality and histology were analyzed.
Results:
Disease duration at surgery was 2 years. Valve replacement was the procedure most frequently performed (53%), followed by pericardial window (37%). At least one postoperative complication developed in 63% (mainly infections). An aortic cross-clamp time≥76minutes was associated with at least one postoperative complication (OR 6.4, 95% CI 1.1-35.4, p=.03). Early death occurred in 5 patients (17%) and late in 3 (10%); main causes were sepsis and heart failure. Disease activity was associated with pericardial window (OR 12.6, 95% CI 1.9-79, p=.007); lymphopenia≤1.200 (OR 10.1, 95% CI 1.05-97, p=.04); age≤30 years (OR 7.7, 95% CI 1.2-46.3, p=.02); and New York Heart Association class III (OR 7.0, 95% CI 1.1-42, p=.03). Postoperative infection was associated with length of hospital stay≥2 weeks (OR 54.9, 95% CI 5.0-602.1, p=.001); intensive care unit stay≥10 days (OR 20, 95% CI 1.6-171.7, p=.01); duration of mechanical ventilation≥5 days (OR 16.9, 95% CI 1.5-171.7, p=.01); and pulmonary artery systolic pressure≥50mmHg (OR 7.8, 95% CI 1.4-41.2, p=.01).
Conclusions:
Cardiac surgery in SLE confers high morbidity and mortality. SLE-specific preoperative risk scores should be designed to identify prognostic factors.
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