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Coronary artery bypass grafting in patients with chronic lymphocytic leukemia
S J Finck1, K J Cockerill, J E Jeter
1Section of Cardiovascular and Thoracic Surgery, Mayo Clinic Jacksonville, Florida 32224.
Insights
Elderly patients with chronic lymphocytic leukemia (CLL) can safely undergo coronary artery bypass grafting (CABG). While mortality is acceptable, patients face an increased risk of postoperative infections, necessitating careful management.
Area of Science:
- Cardiology
- Oncology
- Geriatrics
Background:
- Chronic lymphocytic leukemia (CLL) is a common hematologic malignancy in the elderly.
- Patients with CLL often have immunodeficiency, raising concerns about surgical risks, particularly postoperative sepsis.
- Open cardiac procedures in this population have been approached with caution due to infection risks.
Purpose of the Study:
- To evaluate the safety and outcomes of coronary artery bypass grafting (CABG) in elderly patients diagnosed with chronic lymphocytic leukemia (CLL).
- To assess the operative mortality and postoperative complication rates, specifically focusing on infection risks.
Main Methods:
- Retrospective review of medical records for 26 elderly patients (mean age 69.6 years) with CLL who underwent CABG between 1975 and 1990.
- Analysis included isolated CABG (19 patients) and combined procedures (7 patients).
- Data collected on operative mortality, types of postoperative infections, and length of hospital stay.
Main Results:
- The overall operative mortality rate was 7.7%.
- Postoperative infections occurred in 23.1% of patients, including pneumonia, sternal osteomyelitis, parotiditis, and bacteremia.
- One patient died due to Serratia pneumonitis; 92.3% of patients were discharged within an average of 10.6 days.
Conclusions:
- Coronary artery bypass grafting is a viable option for elderly patients with chronic lymphocytic leukemia, demonstrating acceptable operative mortality.
- A significant increased risk of postoperative infections should be anticipated and managed proactively in this patient cohort.
- Careful patient selection and perioperative management are crucial for optimizing outcomes in CLL patients undergoing CABG.
Abstract:
Chronic lymphocytic leukemia is a disease of the elderly. It tends to have a variable clinical course. Because of the patients' immunologically dysfunctional state, there has been reluctance to perform open cardiac procedures because of concern about early postoperative sepsis leading to death. To assess the risk of coronary artery bypass grafting in elderly patients, the records of 26 patients (mean age, 69.6 +/- 4.9 years) with chronic lymphocytic leukemia who underwent coronary artery bypass grafting between January 1975 and July 1990 were retrospectively reviewed. Nineteen underwent isolated coronary artery bypass grafting, and 7 had combined procedures. The operative mortality rate was 7.7%. Postoperative infections developed in 6 patients (23.1%): pneumonia in 3 and sternal osteomyelitis, acute parotiditis, and bacteremia in 1 each. One of these 6 patients died of acute Serratia pneumonitis. Twenty-four patients (92.3%) were discharged from the hospital an average of 10.6 +/- 7.7 days postoperatively. Patients with chronic lymphocytic leukemia can undergo coronary artery bypass grafting with acceptable mortality but with increased risk of postoperative infection.