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J Thorac Cardiovasc Surg 2004;127:414-420
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Increased morbidity and mortality in patients with antiphospholipid syndrome undergoing valve replacement surgery

^a Department of Pediatrics, Bikur Cholim Hospital, Jerusalem, Israel
^b Department of Cardiothoracic Surgery, Hadassah University Hospital, Jerusalem, Israel
^c Department of Pathology, Hadassah University Hospital, Jerusalem, Israel
^d Department of Medicine, Hadassah University Hospital, Jerusalem, Israel

Received for publication February 16, 2003; revisions received July 3, 2003; accepted for publication July 14, 2003.

^* Address for reprints: Amir Elami, MD, Cardiothoracic Surgery, PO Box 12000, Jerusalem 91120, Israel
eamir{at}md2.huji.ac.il

OBJECTIVE: Heart valve abnormalities are commonly found in patients with antiphospholipid syndrome but experience with valve replacement in such patients is limited. We analyzed the results of valve replacement in patients with this condition at our institution.

METHODS: Between 1989 and 2002, 10 patients with antiphospholipid syndrome (8 women, 2 men; aged 38-73 years, mean 49 years) with severe mitral valve disease (n = 7), aortic valve disease (n = 2), or combined mitral-aortic disease (n = 1) underwent valve replacement. We reviewed retrospectively their clinical data, operative and postoperative courses, and the long-term results. Pathological reassessment was performed in all cases.

RESULTS: Procedures performed included mitral valve replacement in 7 patients, aortic valve replacement in 2 patients, and combined aortic valve replacement plus mitral valve replacement in 1 patient. In addition, 2 patients underwent tricuspid annuloplasty. The immediate mortality was 20% (2 patients). Major complications occurred in 2 other cases. During a follow-up period of up to 8 years, 2 patients required repeat operation for valve-related complications (1 death). An additional patient died of cardiac causes 13 months after surgery. One patient had major thromboembolic events 3 and 10 months after the operation. The late outcome was uneventful in only 4 patients.

CONCLUSION: Valve replacement in patients with antiphospholipid syndrome may carry significant early and late mortality and morbidity, particularly when such patients are referred with advanced valvular heart disease.

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