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. 2023 Mar 27;13(4):891.
doi: 10.3390/life13040891.

Heart Valve Surgery in Antiphospholipid Syndrome Patients-Morbidity and Mortality

Tali Eviatar  1   2 , Stanley Niznik  2   3 , Ori Elkayam  1   2 , Yanai Ben-Gal  2   4 , Ronen Shavit  2   3 , Ehud Raanani  2   5 , Nancy Agmon-Levin  2   3 , Daphna Paran  1   2
Affiliations

Heart Valve Surgery in Antiphospholipid Syndrome Patients-Morbidity and Mortality

Tali Eviatar et al. Life (Basel). .

Abstract

Objectives: To assess valve surgery outcomes in antiphospholipid syndrome (APS).

Methods: A retrospective study assessing complications and mortality rate and possible factors associated with adverse outcomes of APS patients undergoing valve surgery in two tertiary medical centers.

Results: Twenty-six APS patients (median age at surgery 47.5 years) who underwent valve surgery were detected, of whom 11 (42.3%) had secondary APS. The mitral valve was most commonly involved (n = 15, 57.7%). A valve replacement was performed in 24 operations (92.3%), 16 of which (66.7%) were mechanical valves. Fourteen (53.8%) patients sustained severe complications, and four of them died. The presence of mitral regurgitation (MR) was associated with severe complications and mortality (odds ratio (95% confidence interval) 12.5 (1.85-84.442), p = 0.008, for complications. All deceased patients had MR (p = 0.033). The presence of Libman-Sacks endocarditis (LSE) (7.333 (1.272-42.294), p = 0.045), low C3 (6.667 (1.047-42.431), p = 0.05) and higher perioperative prednisone doses (15 ± 21.89 vs. 1.36 ± 3.23 mg/day, p = 0.046) were also associated with complications. A lower glomerular filtration rate (GFR) was associated with mortality (30.75 ± 19.47 vs. 70.68 ± 34.44 mL/min, p = 0.038).

Conclusions: Significant morbidity and mortality were observed among APS patients undergoing valve surgery. MR was associated with mortality and complications. LSE, low complement and higher doses of corticosteroids were associated with complications, while a low GFR was associated with mortality.

Keywords: antiphospholipid syndrome; mitral valve replacement; systemic lupus erythematosus; valve surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Variables significantly associated with total severe complications or mortality. Panel (A). Total severe complications associated with the presence of moderate-to-severe mitral regurgitation (MR), p = 0.008. Panel (B). Total mortality associated with presence of moderate-to-severe MR, p = 0.033. Panel (C). Mean ± standard deviation peri-surgical prednisone dose in mg/day in anti-phospholipid syndrome (APS) patients undergoing valve surgeries with and without severe complications, p = 0.046. Panel (D). Boxplot of glomerular filtration rate (GFR) (MDRD equation) in mL/min according to mortality of APS patients after valve surgery, p = 0.038.
See this image and copyright information in PMC

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