Massoudy Parwis, Thielmann Matthias, Müller-Beissenhirtz Hannes, Görlinger Klaus, Dietrich Wulf, Herget-Rosenthal Stefan, Jakob Heinz
Department for Thoracic and Cardiovascular Surgery, West German Heart Center Essen, Hufelandstrasse 55, Essen, Germany.
J Card Surg. 2009 Jul-Aug;24(4):379-82. doi: 10.1111/j.1540-8191.2008.00761.x.
Thrombophilia may cause severe complications in cardiac surgical patients. We analyzed our experience with symptomatic factor V Leiden patients.
Over an eight-year period, 14 symptomatic patients previously diagnosed with activated protein C resistance,caused by factor V Leiden, underwent a cardiac surgical procedure. We retrospectively reviewed the clinical data, operative and postoperative courses, and the intermediate-term results of these patients.
Procedures performed were coronary artery bypass grafting (CABG, 10 patients), aortic valve replacement+ CABG, pulmonary thromboendarterectomy, left ventricular thrombus removal, and aortic valve reconstruction(one patient each). Eleven patients survived; three patients died perioperatively, one from sepsis (25 days after surgery), one from recurrent stroke (28 days after surgery), and one from multiorgan failure following perioperative stroke (31 days after surgery). In one patient, all bypass grafts occluded intraoperatively.Three patients underwent cardiac surgery under continuous anticoagulation with phenprocoumon. In these three patients, no perioperative thromboembolic events occurred. At a mean follow-up of 32 months,three patients had suffered from cerebral stroke, two from graft occlusion, of which one was recurrent. Two more patients had died (one after cerebral stroke and one from cerebral metastases of a renal cell carcinoma).
In 14 patients with symptomatic factor V Leiden who underwent cardiac surgery, we observed a considerable number of fatal and nonfatal thromboembolic events in the perioperative period and during a 32 months' follow-up. As conducted in three patients, continued anticoagulation with coumarin was safe and prevented perioperative thromboembolic events.
血栓形成倾向可能在心脏外科手术患者中引发严重并发症。我们分析了有症状的因子V莱顿突变患者的治疗经验。
在八年期间，14例先前诊断为因因子V莱顿突变导致活化蛋白C抵抗的有症状患者接受了心脏外科手术。我们回顾性分析了这些患者的临床资料、手术及术后过程以及中期结果。
所施行的手术包括冠状动脉搭桥术（CABG，10例患者）、主动脉瓣置换术+CABG、肺动脉血栓内膜剥脱术、左心室血栓清除术以及主动脉瓣重建术（各1例患者）。11例患者存活；3例患者围手术期死亡，1例死于脓毒症（术后25天），1例死于复发性中风（术后28天），1例死于围手术期中风后的多器官功能衰竭（术后31天）。1例患者术中所有搭桥血管闭塞。3例患者在苯丙香豆素持续抗凝下接受心脏手术。在这3例患者中，未发生围手术期血栓栓塞事件。平均随访32个月时，3例患者发生了脑中风，2例发生了移植血管闭塞，其中1例为复发性。另有2例患者死亡（1例死于脑中风，1例死于肾细胞癌脑转移）。
在14例接受心脏手术的有症状因子V莱顿突变患者中，我们观察到围手术期及32个月随访期间发生了相当数量的致命和非致命性血栓栓塞事件。如3例患者所施行的那样，香豆素持续抗凝是安全的，并预防了围手术期血栓栓塞事件。
