Division of Rheumatology, Department of Internal Medicine, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea.
Clin Exp Rheumatol. 2012 May-Jun;30(3 Suppl 72):S18-26. Epub 2012 Oct 8.
Cardiovascular surgery in patients with Behçet's disease (BD) frequently leads to postoperative complications such as anastomotic leakage, occlusion or pseudoaneurysm. We evaluated the clinical outcomes and related risk factors of postoperative complications in BD patients undergoing cardiovascular surgeries, as well as the long-term efficiency of postoperative immunosuppressive treatment.
Forty-one patients with BD who had undergone cardiovascular surgery between 1990 and 2009 were studied. We evaluated the patients' clinical data, postoperative complications, and survival rate. Risk factors related to the occurrence of postoperative complications were identified by univariate analysis using the Kaplan-Meier method with the log-rank test and multivariate analysis using the Cox proportional hazards regression model.
Fifty-nine operations were performed in 41 patients. During the mean follow-up period of 65.3±48.1 months, complications such as paravalvular leakage, dehiscence, fistula, graft occlusion, or pseudoaneurysm occurred in 29 operations (49.2%). The cumulative occurrence rate of postoperative complication was 10.2% at three months, 32.8% at 12 months, and 43.8% at 24 months. Upon univariate analysis, young age, high Creactive protein levels, lack of postoperative immunosuppression, and short disease duration were identified as significant factors responsible for the occurrence of postoperative complications. In multivariate analysis, postoperative immunosuppression was found to independently lower the risk of complications. The 5-year survival rate was significantly higher in patients with postoperative immunosup immunosuppression than in those without (84.5% vs. 45.0%, p=0.011).
The present study suggests that postoperative immunosuppressive therapy after cardiovascular surgeries in BD patients is important for reducing the development of serious postoperative complications.
贝切特病（BD）患者行心血管手术后常发生吻合口漏、闭塞或假性动脉瘤等术后并发症。本研究评估了 BD 患者行心血管手术后的临床结局及术后并发症的相关危险因素，以及术后免疫抑制治疗的长期效果。
研究纳入了 1990 年至 2009 年间接受心血管手术的 41 例 BD 患者。评估患者的临床资料、术后并发症及生存率。采用 Kaplan-Meier 法和 Log-rank 检验进行单因素分析，采用 Cox 比例风险回归模型进行多因素分析，以确定术后并发症发生的相关危险因素。
41 例患者共行 59 次手术。在平均 65.3±48.1 个月的随访期间，29 次手术（49.2%）发生瓣周漏、愈合不良、瘘管、移植物闭塞或假性动脉瘤等并发症。术后 3 个月、12 个月和 24 个月的累积并发症发生率分别为 10.2%、32.8%和 43.8%。单因素分析显示，年龄较小、C 反应蛋白水平较高、术后未行免疫抑制治疗和疾病病程较短与术后并发症的发生有关。多因素分析显示，术后免疫抑制治疗可降低并发症的发生风险。行术后免疫抑制治疗患者的 5 年生存率明显高于未行免疫抑制治疗患者（84.5% vs. 45.0%，p=0.011）。
本研究表明，BD 患者心血管手术后行术后免疫抑制治疗对于减少严重术后并发症的发生非常重要。
