Patients with Systemic Lupus Erythematosus and Antiphospholipid Syndrome Undergoing Cardiac Valve Surgery

Background and aim of the study: Systemic lupus erythematosus (SLE) and primary/secondary antiphospholipid syndrome (APLS) may cause early degenerative changes in cardiac valves, such as Libman-Sacks endocarditis, though few reports exist of this condition. Herein are presented the early and late clinical outcomes after cardiac valve surgery in Patients diagnosed with SLE and APLS in a single center experience. Methods: A prospective analysis was conducted of the perioperative and follow up data acquired from patients with diagnosed SLE, and primary and secondary APLS, who underwent either single or combined valve surgery at the authors' department between 2002 and 2014. Results: Fifteen patients (14 females, one male; mean age 53 +/- 16 years; range: 16-77 years) were identified. The mean follow up time was 49 +/- 32 months (range: 12.5-119 months). Thirteen patients (11 females, two males) were diagnosed with SLE; one of these patients had tricuspid Libman-Sacks endocarditis, while two female patients had primary APLS and four had secondary APLS. Besides bioprosthetic and mechanical valve replacements, mitral and tricuspid valve reconstruction were performed. The mean cross-clamp time was 112 +/- 73 min (range: 55-294 min). Early major cardiovascular events occurred in two patients, and late non-fatal events in four patients, including one thromboembolic event. The 30-day and in-hospital mortalities were both 0%. Currently, 12 patients (80%) are alive at the end of follow up. Actuarial survival was 92 +/- 7.4% at one year, 74 +/- 18% at four years, and 49 +/- 23% at ten years. Conclusion: Despite general concerns, the present results confirmed that patients with SLE and APLS can be operated on for cardiac valve disease, with favorable early results and acceptable long-term outcome.