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Observational Study
. 2014 Jul;46(1):116-20.
doi: 10.1093/ejcts/ezt572. Epub 2013 Dec 19.

Outcomes of patients with antiphospholipid syndrome after pulmonary endarterectomy

Julien Camous  1 , Thibaut Decrombecque  1 , Virginie Louvain-Quintard  2 , Sylvie Doubine  2 , Philippe Dartevelle  3 , François Stéphan  4
Affiliations
Observational Study

Outcomes of patients with antiphospholipid syndrome after pulmonary endarterectomy

Julien Camous et al. Eur J Cardiothorac Surg. 2014 Jul.

Abstract

Objectives: Antiphospholipid syndrome (APS) is a risk factor for chronic thromboembolic pulmonary hypertension, for which the treatment of choice is pulmonary endarterectomy. The increased risk of postoperative thrombotic complications in patients with APS may complicate the perioperative management. The primary objective of this study was to investigate the impact of APS on mortality and morbidity rates after pulmonary endarterectomy. The secondary objective was to describe platelet count changes after pulmonary endarterectomy in patients with APS.

Methods: Data were collected prospectively for consecutive patients with APS who underwent pulmonary endarterectomy over a 5-year period [2007-2011] and for consecutive patients without APS who underwent pulmonary endarterectomy at the same centre during 2008-2011 [controls]. Major complications and daily platelet counts were collected. Haemodynamic parameters obtained by right heart catheterisation were recorded preoperatively and on the day after surgery.

Results: We identified 17 patients with APS [3.6% of all pulmonary endarterectomies] and 190 controls. Early haemodynamic results after pulmonary endarterectomy were similar in the two groups, with a greater than 35% decrease in pulmonary vascular resistance. Significantly higher proportions of patients with APS than of controls experienced stroke [11.8 vs 1.0%, P= 0.03] and delirium [47 vs 20%; P = 0.02]. Compared with the controls, the patients with APS had significantly lower platelet counts and had a higher occurrence rate of platelet counts of ≤ 50 g/l (71 vs 4%; P < 0.0001). Intensive care unit (ICU) mortality was not significantly different between the two groups [0/17 vs 7/190 (3.7%), P = 0.49].

Conclusions: Neurological complications and severe thrombocytopenia were more common after pulmonary endarterectomy in patients with than without APS. Haemodynamic results and ICU mortality rate were similar in the two groups.

Keywords: Antiphospholipid syndrome; Mortality; Pulmonary endarterectomy; Stroke; Thrombocytopenia.

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