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Cardiac Surgery Outcomes in Patients With Chronic Lymphocytic Leukemia
Yuanjia Zhu1, Andrew J Toth2, Ashley M Lowry2
1Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
Insights
Cardiac surgery in chronic lymphocytic leukemia (CLL) patients showed similar hospital mortality rates compared to non-CLL patients. High-risk CLL patients required more blood products, necessitating careful preoperative management.
Area of Science:
- Cardiology
- Hematology
- Surgical Outcomes
Background:
- Limited data exists on surgical outcomes for patients with chronic lymphocytic leukemia (CLL) undergoing cardiac surgery.
- Investigating hospital morbidity and mortality in CLL patients post-cardiac surgery is crucial for clinical decision-making.
Purpose of the Study:
- To compare hospital morbidity and mortality after open cardiac surgery in patients with CLL versus those without the condition.
- To identify specific risks and management considerations for CLL patients undergoing elective cardiac surgery.
Main Methods:
- A retrospective study analyzed 157 CLL patients and 55,917 non-CLL patients who underwent elective cardiac surgery between May 1995 and May 2015.
- Patients were stratified by Rai criteria for CLL risk (low, intermediate, high).
- Propensity-score matching was used to compare outcomes between CLL and non-CLL groups.
Main Results:
- Hospital mortality rates were similar between CLL (2.5%) and non-CLL (3.0%) patients (p > 0.3).
- Deep sternal wound infection and septicemia rates were also comparable between groups.
- High-risk CLL patients received more blood products (87% vs. 65%) and intermediate-risk CLL patients received more platelet units (mean 12 vs. 4.6).
Conclusions:
- While overall hospital mortality is not increased, high-risk CLL patients undergoing cardiac surgery require more blood product transfusions.
- Careful preoperative assessment and management, including consideration of transfusion strategies and blood-loss reduction techniques, are essential for high-risk CLL patients.
- Transfusion-related risks should be evaluated when considering elective cardiac surgery for CLL patients.
Background:
Surgical outcomes of patients with chronic lymphocytic leukemia (CLL) undergoing cardiac surgery are limited. Our objectives were to investigate hospital morbidity and mortality after open cardiac surgery in CLL versus non-CLL patients.
Methods:
From May 1995 to May 2015, 157 patients with CLL and 55,917 without and older than 47 years underwent elective cardiac surgery at Cleveland Clinic. By Rai criteria, 79 CLL patients (56%) were low risk (class 0), 13 (9.1%) intermediate risk (classes I and II), and 38 (27%) high risk (classes III and IV); 12 (8.5%) were in remission. Mean age of CLL patients was 72 ± 9.0 years, and 18% were women. CLL patients were propensity-score matched to 3 non-CLL patients to compare surgical outcomes.
Results:
High-risk CLL patients received more blood products than matched non-CLL patients (33/38 [87%] versus 74/114 [65%], p = 0.01), but were less likely to receive cryoprecipitate (0% versus 15/114 [13%], p = .02). Intermediate-risk CLL patients received more platelet units, mean 12 versus 4.6 (p = 0.008). Occurrence of deep sternal wound infection (0% versus 5/471 [1.1%]), septicemia (5/157 [3.2%] versus 14/471 [3.0%]), and hospital mortality (4/157 [2.5%] versus 14/471 [3.0%]) were similar (p > 0.3), independent of prior chemotherapy treatment for CLL.
Conclusions:
Although CLL patients did not have higher hospital mortality than non-CLL patients, high-risk CLL patients were more likely to receive blood products. Risks associated with transfusion should be considered when evaluating CLL patients for elective cardiac surgery. Appropriate preoperative management, such as blood product transfusions, and alternative treatment options that decrease blood loss, should be considered for high-risk patients.
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