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Open heart surgery in patients with chronic lymphocytic leukemia
L E Samuels1, M S Kaufman, R J Morris
1Department of Cardiothoracic Surgery, Allegheny University Hospitals, Philadelphia, PA 19102-1192, USA.
Insights
Open heart surgery in chronic lymphocytic leukemia patients has high mortality and morbidity, primarily due to infections. Careful management is crucial for these complex cases.
Area of Science:
- Cardiology
- Hematology
- Oncology
Background:
- Chronic lymphocytic leukemia (CLL) involves malignant lymphocyte proliferation.
- Limited data exists on open heart surgery outcomes in CLL patients.
Purpose of the Study:
- To evaluate the outcomes of open heart surgery in patients with chronic lymphocytic leukemia.
Main Methods:
- Twelve CLL patients underwent open heart surgery (CABG, AVR) between 1991-1996.
- Procedures involved cardiopulmonary bypass (CPB) with moderate hypothermia.
- Patient staging followed the Rai Classification.
Main Results:
- Hospital mortality was 17% (n=2), with sepsis as the cause.
- Hospital morbidity was 58% (n=7), infections being the most frequent complication.
- Eight patients (67%) required blood product transfusions; late mortality was high and non-cardiac related.
Conclusions:
- Open heart surgery in CLL patients is associated with high mortality and morbidity.
- Infection is the leading cause of death and complication.
- Management goals for these patients require re-evaluation.
Background:
Chronic leukemia is a disease characterized by the malignant proliferation of immunologically incompetent lymphocytes. The knowledge of open heart surgery in patients with this disorder is limited.
Methods:
Twelve patients with chronic lymphocytic leukemia underwent open heart surgery (nine coronary artery bypass grafting (CABG), two aortic valve replacement (AVR), one CABG and AVR) from September 1991 to September 1996. There were nine males and three females with a mean age of 68 years (41-81 years). Staging was assigned according to the Rai Classification. There were seven Stage 0, two Stage I, zero Stage II, one Stage III and two Stage IV patients. Cardiopulmonary bypass (CPB) was performed using standard techniques of cannulation, moderate hypothermia and antegrade/retrograde cardioplegia.
Results:
Hospital mortality occurred in two (17%) patients. Both patients died of sepsis. Hospital morbidity occurred in seven (58%) patients. The most common complications were infections. Five patients were found to have other malignancies (basal cell, laryngeal, prostate, bladder and breast cancers). Transfusion of blood products was required in eight (67%) patients. The average length of stay was 15 days (7-50 days). Follow-up was complete. Late mortality occurred in four patients at a mean of 7 months (1-18 months). All deaths were non-cardiac related (ruptured AAA, kidney failure, respiratory failure and sepsis). Six patients remain alive at a mean of 25 months (1-48 months).
Conclusion:
Hospital mortality and morbidity in patients with chronic lymphocytic leukemia undergoing open heart surgery are high. Infection is the leading cause of hospital death, as well as the most common complication. The majority of patients receive blood products during the course of their hospitalization. Late mortality is high and non-cardiac related. Based on these findings, a re-definition of the aims, goals and expectations of open heart surgery in patients with chronic leukemia is necessary. Suggestions in management are presented.
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