[Cardiovascular Surgery for Patients Under Immunosuppressive Therapy]

Area of Science:

• Cardiovascular Surgery
• Immunosuppression Therapy
• Rheumatology

Context:

• Patients with collagen disease or organ transplant recipients often require immunosuppressive agents, including steroids.
• Cardiovascular surgery in these patients presents risks of postoperative infection and wound healing issues.
• Perioperative management strategies are crucial for optimizing outcomes.

Purpose:

• To review key considerations for the perioperative management of patients undergoing cardiovascular surgery while on immunosuppressive therapy.
• To provide guidance on steroid tapering, management of biologic disease-modifying antirheumatic drugs (bDMARDs), and Janus kinase (JAK) inhibitors.
• To highlight the importance of immunosuppressive therapy continuation in certain patient groups and monitoring drug levels.

Summary:

• Steroids should be tapered before elective surgery to mitigate adverse outcomes.
• Biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase (JAK) inhibitors can be withheld in stable collagen disease patients.
• Immunosuppressive therapy must continue for organ transplant recipients and those with severe collagen disease, necessitating close monitoring of drug levels like Tacrolimus to prevent renal complications.

Impact:

• Informed perioperative management can reduce infection and wound healing complications in high-risk surgical patients.
• Optimized immunosuppressive drug regimens improve patient safety and clinical outcomes.
• Collaborative care between surgical, transplant, and rheumatology teams is essential for successful management.