Cardiac surgery in cases of myeloproliferative neoplasm: risk factor for stroke.

OBJECTIVES

a history of myeloproliferative neoplasms is considered to increase the risks in cardiac surgery. In patients with myeloproliferative neoplasms, increased rates of perioperative infections and thromboembolic complications are suspected, but studies analyzing the impact of myeloproliferative neoplasms on results after cardiac surgery are lacking.

METHODS

13 patients with the diagnosis of myeloproliferative neoplasm underwent cardiac surgery. These patients were matched to 36 controls. Matching criteria consisted of sex, age, diagnosis, and comorbidities. Patients were analyzed regarding laboratory parameters, blood transfusion demands, morbidity, and mortality.

RESULTS

compared to controls, patients with myeloproliferative neoplasms demonstrated a significantly lower body-mass index (p<0.01), creatinine (p=0.024), prothrombin time (p=0.001), and urea level (p=0.012). The perioperative leukocyte response (p=0.03) was ameliorated, and platelet counts (p<0.02) increased. Patients with myeloproliferative neoplasms had a reduced need for erythrocyte concentrates (54% vs. 86%, p=0.047) but increased need for plasma and thrombocytes (15% vs. 0%, p=0.07). Patients with myeloproliferative neoplasms had a significantly increased incidence of thromboembolic events compared to controls (31% vs. 3%, p=0.014). Hospital mortality remained at zero, but mid-term survival was lower in patients with myeloproliferative neoplasms (p=0.078).

CONCLUSIONS

myeloproliferative neoplasm as a concomitant diagnosis increases the risk of thromboembolic complications during cardiac surgery. Plasma and platelet substitutions have to be administered, although strokes were not associated with hemostatic treatment.