Cardiac operations in patients with low-grade small lymphocytic malignancies

Background: Low-grade small lymphocytic (B cell) malignancies (encompassing chronic lymphocytic leukemia and some types of non-Hodgkin lymphoma) are d iseases of the elderly. Open cardiac procedures are known to have increased risk of postoperative infection and other morbidities in these immunodefic ient patients. Outcome of open cardiac procedures in these patients was rev iewed retrospectively. Patients: Thirteen patients (aged 58-82 years, 11 me n, 2 women) with these lymphocytopathologic diseases (8 with chronic lympho cytic leukemia and 5 with non-Hodgkin lymphoma) underwent cardiac operation s between January 1977 and June 1998. Mean age was 72 +/- 2.1 years. Isolat ed coronary artery bypass grafting was performed in 11 and combined procedu res and double valve replacement were performed in 1 each. Preoperatively, 9 patients were in a low-risk clinical stage. Mean preoperative duration of lymphocytopathologic disease was 6.1 +/- 1.6 years. Mean preoperative New York Heart Association functional class was 2,8, Results: There was no oper ative death. Average stay in the intensive care unit was 41.4 +/- 8.6 hours . Postoperative leg and superficial sternal wound infections were encounter ed in 3 patients. Average postoperative hospital stay was 10.0 +/- 1.7 days . During the follow-up up to 72 months, 1 patient underwent a second cardia c operation. There was 1 late death 4 Sears later. Coronary stenting was do ne in 1 patient and a cardioverter-defibrillator was implanted in another p atient for recurrent angina. Three patients underwent chemotherapy, Cardiac and lymphocytopathologic status remained stable in others. Conclusions: Ac ceptable outcome mag be anticipated after cardiac operations in patients wi th low-grade chronic lymphocytic leukemia and non-Hodgkin lymphoma in early stages, However, the possibility of infection and progression of cardiac a nd lymphocytopathologic status in these patients should call for caution.