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Vol. 14. Num. 5.September - October 2018
Pages 251-316
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Vol. 14. Num. 5.September - October 2018
Pages 251-316
Original Article
DOI: 10.1016/j.reumae.2017.01.016
Cardiac Surgery in Systemic Lupus Erythematosus Patients: Clinical Characteristics and Outcomes
Cirugía cardiaca en pacientes con lupus eritematoso sistémico: características clínicas y desenlaces
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Javier Tejeda-Maldonadoa, Lauro Quintanilla-Gonzáleza, Jaime Galindo-Uribeb, Andrea Hinojosa-Azaolac,
Corresponding author
andreaha@yahoo.com

Corresponding author.
a Departamento de Medicina Interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
b Departamento de Cardiología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
c Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Tables (6)
Table 1. Comorbidities and Demographic Characteristics and of Systemic Lupus Erythematosus at Diagnosis.
Table 2. Characteristics of Systemic Lupus Erythematosus at the Moment of Surgery.
Table 3. Characteristics of Cardiac Surgery.
Table 4. Main Sites of Infection.
Table 5. Postoperative Outcome in Accordance With the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) Activity Index.
Table 6. Characteristics of the Patients With and Without Postoperative Infections.
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Abstract
Objectives

To study the clinical characteristics and outcomes in systemic lupus erythematosus (SLE) patients who underwent cardiac surgery.

Methods

Retrospective analysis of 30 SLE patients who underwent cardiac surgery at a single center. Demographics, comorbidities, clinical and serologic characteristics, cardiovascular risk scores and treatment were recorded. Type of surgery, postoperative complications, mortality and histology were analyzed.

Results

Disease duration at surgery was 2 years. Valve replacement was the procedure most frequently performed (53%), followed by pericardial window (37%). At least one postoperative complication developed in 63% (mainly infections). An aortic cross-clamp time ≥76min was associated with at least one postoperative complication (OR 6.4, 95% CI 1.1–35.4, P=.03). Early death occurred in 5 patients (17%) and late in 3 (10%); main causes were sepsis and heart failure. Disease activity was associated with pericardial window (OR 12.6, 95% CI 1.9–79, P=.007); lymphopenia1.200 (OR 10.1, 95% CI 1.05–97, P=.04); age30 years (OR 7.7, 95% CI 1.2–46.3, P=.02); and New York Heart Association class III (OR 7.0, 95% CI 1.1–42, P=.03). Postoperative infection was associated with length of hospital stay2 weeks (OR 54.9, 95% CI 5.0–602.1, P=.001); intensive care unit stay10 days (OR 20, 95% CI 1.6–171.7, P=.01); duration of mechanical ventilation ≥5 days (OR 16.9, 95% CI 1.5–171.7, P=.01); and pulmonary artery systolic pressure ≥50mmHg (OR 7.8, 95% CI 1.4–41.2, P=.01).

Conclusions

Cardiac surgery in SLE confers high morbidity and mortality. SLE-specific preoperative risk scores should be designed to identify prognostic factors.

Keywords:
Systemic lupus erythematosus
Cardiac surgery
Valve replacement
Pericardial window
Resumen
Objetivos

Estudiar las características clínicas y desenlaces de los pacientes con lupus eritematoso sistémico (LES) intervenidos de cirugía cardiaca.

Métodos

Se realizó un estudio retrospectivo de 30 pacientes con LES y cirugía cardiaca en un solo centro. Se registraron comorbilidades, características demográficas, clínicas, serológicas, riesgo cardiovascular, tratamiento, tipo de cirugía, complicaciones postoperatorias, mortalidad e histología.

Resultados

La duración de LES al momento de la cirugía fue de 2 años. El procedimiento más frecuente fue recambio valvular (53%), seguido de ventana pericárdica (37%). Al menos una complicación postoperatoria se presentó en el 63% (principalmente infecciones). Un pinzamiento aórtico76min se asoció con al menos una complicación (OR 6,4; IC 95% 1,1–35,4, p=0,03). La mortalidad temprana ocurrió en 5 pacientes (17%) y tardía en 3 (10%); siendo las causas principales sepsis e insuficiencia cardiaca. La actividad de la enfermedad se asoció a la realización de ventana pericárdica (OR 12,6; IC 95% 1,9–79; p=0,007), presencia de linfopenia1.200 (OR 10,1; IC 95% 1,05–97; p=0,04), edad30 años (OR 7,7; IC 95% 1,2–46,3; p=0,02) y NYHA clase III (OR 7,0; IC 95% 1,1–42, p=0,03). El desarrollo de infección postoperatoria se asoció con estancia hospitalaria2 semanas (OR 54,9; IC 95% 5,0–6021; p=0,001), estancia en UCI10 días (OR 20; IC 95% 1,6–171,7, p=0,01), duración de ventilación mecánica ≥ 5 días (OR 16,9, IC 95% 1,5–171,7, p = 0,01) y PSAP50mmHg (OR 7,8; IC 95% 1,4–41,2; p=0,01).

Conclusiones

La cirugía cardiaca en LES se asocia a alta morbimortalidad.

Palabras clave:
Lupus eritematoso sistémico
Cirugía cardiaca
Recambio valvular
Ventana pericárdica

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