Abstract 13880: Autoimmune Connective Tissue Diseases and Cardiac Surgery

Abstract

Introduction: The results of cardiac surgery in patients affected by autoimmune connective tissue diseases (ACTD) have not been extensively reported. Accordingly, we sought to assess the outcomes of ACTD patients after cardiac surgery, focusing on postoperative complications and survival at short and long term. Methods: Since 2008, 1002 cardiac surgical patients affected by ACTD (rheumatoid arthritis (RA) 59%, autoimmune vasculitis 14%, autoimmune inflammatory disease 12%, psoriatic arthritis 9%, and systemic lupus erythematosus (SLE) 6%), were retrospectively analysed in two centres. Demographics, clinical characteristics and specific treatment were recorded. Type of surgery, postoperative complications, early and late mortality were analysed. Results: Median age was 71 (22-92) years, and 48% were female. Most patients presented severe comorbidities (shown in the table) and required urgent surgery in 17% of cases, most frequently CABG (56%). Perioperative mortality was 2% but 60% of patients developed postoperative complications (mainly acute renal failure 15%). Patients affected by systemic inflammatory autoimmune diseases needed longer time of mechanical ventilation (p<0.01), while those with vasculitis more frequently had pneumonia (p=0.05). SLE patients had higher 30-day mortality (7%, p=0.04). Survival at 1, 5 and 10 years was 97±1%, 82±1% and 59±2%, respectively, and most common causes of death were not cardiac related (75%). By multivariate analysis, RA (HR 1.30, 1.00-1.70) was a risk factor for late mortality while both SLE and vasculitis were risk factors for re-operation (p=0.04 and p<0.01, respectively), at a median follow up of 59 months (1-184). Conclusions: Cardiac surgery in ACTD patients can achieve satisfactory short- and long-term results despite higher rate of postoperative complications, mainly renal failure and infections.