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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Coronary artery bypass grafting in patients with hematological neoplasms
Lixue Zhang1, Simeng Zhang1, Hao Jiang2
1Department of Cardiac Surgery, Peking University People's Hospital, Beijing, China.
Insights
Coronary artery bypass grafting (CABG) is safe for patients with stable hematological neoplasms, with prognosis linked to preoperative blood cell counts. Multidisciplinary care is crucial for optimizing outcomes in these complex cases.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Oncology
Background:
- Coronary artery bypass grafting (CABG) in patients with concurrent coronary artery disease (CAD) and hematological neoplasms presents significant challenges.
- Immunosuppression, hematologic dysfunction, and coagulopathy complicate surgical management in this patient cohort.
Purpose of the Study:
- To assess the safety and feasibility of CABG in patients with coexisting CAD and hematological neoplasms.
- To identify factors influencing the prognosis of CABG in this specific patient population.
Main Methods:
- Retrospective analysis of 41 patients with CAD and hematological neoplasms undergoing CABG (2018-2023).
- Stratification of patients based on hematological disease status (stable, disease-free, progressive).
- Analysis of perioperative outcomes, graft patency, survival data, and Cox regression for prognostic predictors.
Main Results:
- CABG was performed with no perioperative mortality in patients with stable hematological neoplasms.
- Preoperative blood cell levels were identified as independent predictors of survival (p < 0.05).
- Graft patency was high (92.3%), with major infections in 4.9% and 22% mortality during follow-up, primarily due to hematological progression.
Conclusions:
- CABG is a safe option for most patients with stable hematological neoplasms, enabling subsequent hematological treatments.
- Preoperative hematological status significantly impacts prognosis, highlighting the need for integrated, multidisciplinary management.
- Further large-scale studies are required to validate findings and refine treatment strategies for this complex group.
Background:
Coronary artery bypass grafting (CABG) in patients with concurrent coronary artery disease (CAD) and hematological neoplasms presents unique challenges due to immunosuppression, hematologic dysfunction, and coagulopathy. This study aimed to assess the safety and feasibility of CABG in this population and to evaluate factors influencing prognosis.
Methods:
This retrospective study included 41 patients with CAD and hematological neoplasms who underwent CABG between 2018 and 2023. Hematological neoplasms were classified into seven categories, and patients were stratified by hematological disease status: stable, disease-free, or progressive. Key perioperative outcomes, graft patency, and survival data were analyzed. Cox regression models identified independent predictors of prognosis.
Results:
Of the 41 patients, 28 (68.3%) were stable, 10 (24.4%) were disease-free, and 3 (7.3%) were progressive. The median preoperative platelet count was 143 × 109/L, with 8 patients presenting counts <50 × 109/L requiring preoperative platelet transfusions. Postoperative transfusion rates for packed red blood cells (PRBCs), fresh frozen plasma (FFP) and platelets were 51.2%, 39.0%, and 12.2%, respectively. The median operation time was 210 min, with 87.8% undergoing off-pump CABG. Graft patency at discharge was 92.3%. Major infections occurred in 4.9% of patients, and 9 (22%) deaths were recorded during follow-up, 8 due to hematological progression and 1 due to myocardial infarction. Cox regression identified preoperative blood cell levels as independent predictors of survival (p < 0.05), while CABG-related factors showed no significant association (p > 0.05).
Conclusions:
CABG can be performed safely in most patients with stable hematological neoplasms, with no perioperative mortality, providing an opportunity for further hematological treatments. Preoperative blood cell levels significantly influence prognosis, underscoring the importance of multidisciplinary management. Larger studies are needed to validate these findings and refine treatment strategies.
