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Heart of the Matter: Effect of CLL on Outcomes From Elective Cardiac Surgery

By: Emily Rhode
Posted: Thursday, October 7, 2021

According to research presented in The Annals of Thoracic Surgery, patients with chronic lymphocytic leukemia (CLL) who undergo elective cardiac operations may have an increased need for blood transfusions. Also, they may be more likely to be readmitted within 90 days of discharge. According to Peyman Benharash, MD, of the David Geffen School of Medicine, Los Angeles, and colleagues, “blood-conserving interventions may be considered in this at-risk population to improve outcomes.”

The study included a 3:1 propensity-matched cohort of 2,898 patients with CLL and 8,378 patients without CLL, all of whom had undergone elective cardiac surgeries. Even though they were older on average than their non-CLL counterparts, patients with CLL had a similar burden of comorbidities (P = .24). The cardiac operations included coronary artery bypass grafting as well as valve repair or replacement.

Overall, mortality and perioperative complications did not seem to differ significantly between the two cohorts (P = .08 and P = .92, respectively). However, patients with CLL were more likely to require blood product transfusions (33.7 vs. 28.4%, P = .003) and were also more frequently readmitted for nonelective reasons within 90 days of discharge. The reason for readmission was more often due to respiratory issues in patients with CLL compared with the non-CLL cohort (23.6 vs. 13.9%, P = .001).

The authors noted several limitations to their study. They include the inability to stratify the severity of CLL in patients, risk stratification, and other clinical variables that may have influenced outcomes.

“We have demonstrated the safety of several cardiac operative categories in these patients despite the increased requirement for blood products,” the study authors concluded. “Further work is necessary in order to optimize cardiac surgery outcomes in patients with CLL.”

Disclosure: For full disclosures of the study authors, visit annalsthoracicsurgery.org.



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