Hematological malignancies are disorders characterized by malignant proliferation of immunologically incompetent leukocytes. There has been limited assessment of post-operative outcomes after open cardiac surgery in this patient population. Our study retrospectively reviewed outcomes after open cardiac procedures in these patients.
Twenty nine patients (ages 50-88 years, 24 men, 5 women) with hematological maliagnancies (11 chronic myelogenous leukemia (CML), 8 chronic lymphocytic leukemia (CLL), 7 with non-Hodgkin’s lymphoma (NHL), 2 Hodgkin’s lymphoma (HL) and 1 multiple myeloma) underwent open cardiac surgery (21 coronary artery bypass grafting (CABG), 2 aortic valve replacement (AVR), 2 CABG and AVR, 2 CABG, AVR and mitral valve replacement (MVR) and 1 pericardiectomy) in our institution between January 2000 and March 2004. The mean age was 71 ± 2.5 years. The mean ejection fraction was 39.75%. Sixteen patients underwent CABG and cardiopulmonary bypass (CPB) performed using standard techniques of cannulation, moderate hypothermia and antegrade/retrograde cardioplegia. The rest underwent CABG without CPB (off pump).
Hospital mortality occurred in two (6.9%) patients. Morbidity occurred in eight (26.6%) patients. Four (13.8%) had respiratory failure requiring prolonged mechanical ventilation, two patients developed renal failure, one had stroke and one developed sepsis in the immediate post operative period. There were no sternal wound infections. The average length of hospital stay was 11.72 days (3-74) days and the average length of post operative intensive care unit (ICU) stay was 6.68 days (1–68 days).
The hospital mortality, morbidity and post-operative ICU and hospital stay in patients with hematological malignancies undergoing open cardiac surgery is highter than the general population. Respiratory failure, renal failure, sepsis and stroke are among the major causes for the prolonged post-operative stay and mortality.
Open cardiac procedures performed in patients with hematological malignancies carry an increased risk of post-operative complications, mortality and prolonged hospital stay. These findings call for caution during patient selection.
S. Bala, None.