Open heart surgery in patients with chronic lymphocytic leukemia

Background: Chronic leukemia is a disease characterized by the malignant pr oliferation of immunologically incompetent lymphocytes. The knowledge of op en heart surgery in patients with this disorder is limited. Methods: Twelve patients with chronic lymphocytic leukemia underwent open heart surgery (n ine coronary artery bypass grafting (CABG), two aortic valve replacement (A VR), one CABG and AVR) from September 1991 to September 1996. There were ni ne males and three females with a mean age of 68 years (41-81 years). Stagi ng was assigned according to the Rai Classification. There were seven Stage 0, two Stage I, zero Stage II, one Stage III and two Stage IV patients. Ca rdiopulmonary bypass (CPB) was performed using standard techniques of cannu lation, moderate hypothermia and antegrade/retrograde cardioplegia. Results : Hospital mortality occurred in two (17%) patients. Both patients died of sepsis. Hospital morbidity occurred in seven (58%) patients. The most commo n complications were infections. Five patients were found to have other mal ignancies (basal cell, laryngeal, prostate, bladder and breast cancers). Tr ansfusion of blood products was required in eight (67%) patients. The avera ge length of stay was 15 days (7-50 days). Follow-up was complete. Late mor tality occurred in four patients at a mean of 7 months (1-18 months). All d eaths were non-cardiac related (ruptured AAA, kidney failure, respiratory f ailure and sepsis). Six patients remain alive at a mean of 25 months (1-48 months). Conclusion: Hospital mortality and morbidity in patients with chro nic lymphocytic leukemia undergoing open heart surgery are high. Infection is the leading cause of hospital death, as well as the most common complica tion. The majority of patients receive blood products during the course of their hospitalization. Late mortality is high and non-cardiac related. Base d on these findings, a re-definition of the aims, goals and expectations of open heart surgery in patients with chronic leukemia is necessary. Suggest ions in management are presented. (C) 1998 Published by Elsevier Science Lt d. All rights reserved.