Clonal Hematopoiesis Is Associated With Long-Term Adverse Outcomes Following Cardiac Surgery

Area of Science:

• Cardiology
• Genetics
• Immunology

Background:

• Cardiac surgery elicits innate immune responses, potentially causing postoperative complications.
• Clonal hematopoiesis (CH) is linked to short-term outcomes post-cardiac surgery, but its long-term impact is unclear.

Purpose of the Study:

• To investigate the association between clonal hematopoiesis and long-term clinical outcomes in patients undergoing cardiac surgery.

Main Methods:

• A cohort study included patients undergoing elective cardiac surgery between January 2017 and September 2019.
• Patients were screened for CH using a 19-gene panel.
• Clinical events, including all-cause death and major adverse cardiac and cerebral events, were recorded. The primary outcome was a composite of all-cause mortality and major adverse cardiac and cerebral events.

Main Results:

• Of 314 patients, 139 (44%) had CH. CH carriers had a higher incidence of prior atrial fibrillation.
• The most common mutations were in DNMT3A, TET2, and ASXL1 genes.
• After a median follow-up of 1203 days, CH was independently associated with an 88% increased risk of the primary outcome (HR, 1.88; P=0.035).

Conclusions:

• Clonal hematopoiesis is prevalent in cardiac surgery patients and signifies a doubled long-term risk of major adverse clinical outcomes.
• CH represents a novel risk factor for long-term complications after cardiac surgery, potentially aiding in personalized management strategies.