Aortic valve replacement in a patient with systemic lupus erythematosus

Kansara, Bhuvnesh; Singh, Ajmer; Karlekar, Anil; Mishra, Yugal

doi:10.4103/0970-9185.111656

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Limited prior work has characterized acute outcomes in AID patients undergoing cardiac procedures. 13 Similar to these, we report no difference in mortality rates and overall acceptable outcomes for AID patients undergoing elective CABG or valve operations. 5,[14][15][16] While AID patients are known to present with higher levels of inflammatory markers and face systemic disease manifestations, they may also be immunosuppressed.…”

Section: Discussionsupporting

confidence: 82%

Acute Outcomes of Cardiac Operations in Patients With Autoimmune Disorders: A National Analysis

Bakhtiyar

Kim

Ali

et al. 2023

The American Surgeon™

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Background Accelerated atherosclerosis, inflammation, and valve pathology are known complications of autoimmune connective tissue diseases (AID). However, outcomes of coronary artery bypass graft surgery (CABG) or valve operations among these patients remain underexamined. Methods All adult hospitalizations for elective CABG or valve procedures were identified from the 2010-2019 Nationwide Readmissions Database. Autoimmune connective tissue disease was defined to include systemic lupus erythematosus (SLE), antiphospholipid syndrome (APLS), polymyalgia rheumatica (PMR), and other autoimmune AIDs. Entropy balancing was applied to generate balanced patient cohorts. Multivariable regression models were constructed to assess the independent associations between AID and outcomes of interest. Results Of ∼1 652 573 patients, 21 019 (1.3%) had AID (23.7% SLE, 17.2% APLS, 29.5% PMR, and 29.6% other). Autoimmune connective tissue disease patients were more frequently female (60.8 vs 33.1%, P < .001) and insured by Medicare (71.4 vs 62.2%, P < .001) and presented with a higher comorbidity index (5.2 ± 1.8 vs 4.1 ± 1.8, P < .001). Further, AID less frequently underwent isolated CABG (39.0 vs 52.3%) but more commonly isolated valve operations (41.9% vs 31.0%, P < .001), relative to non-AID. Following risk-adjustment, AID was not linked with increased odds of mortality or cardiac complications. However, AID was linked with a greater risk of thrombotic complications, blood transfusion, and non-elective readmission within 30 days, as well as a +$900 decrement in hospitalization costs. Discussion Autoimmune connective tissue disease patients demonstrated acceptable outcomes following CABG and valve procedures. However, novel prophylactic care pathways should be developed and instituted to address greater thrombotic and blood transfusion risk. Further investigation is needed to identify factors contributing to greater non-elective readmissions among these patients.

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Section: Discussionsupporting

confidence: 82%

Acute Outcomes of Cardiac Operations in Patients With Autoimmune Disorders: A National Analysis

Bakhtiyar

Kim

Ali

et al. 2023

The American Surgeon™

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“…The pathogenic mechanism of aortic valve pathology is poorly understood. Although it was linked to antiphospholipid syndrome [34], severe aortic insufficiency was reported without aPLs [11, 35].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Manifestations in Systemic Lupus Erythematosus: Clinical Correlates of Subclinical Echocardiographic Features

Mohamed

Hammam

Zohri

et al. 2019

BioMed Research International

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Objectives This study aims to correlate subclinical echocardiographic features with the clinical, laboratory, and therapeutic profiles of the patients to characterize risks for systemic lupus erythematosus (SLE) cardiac diseases. Methods The study included 59 SLE patients. Demographic data, disease characteristics, and current therapies were recorded, and the anthropometric measurements and routine laboratory tests were performed. The disease activity by the SLE Disease Activity Index-2K (SLEDAI2K) and the presence of metabolic syndrome (MetS) were assessed. Two-dimensional echocardiography was performed. Results The mean age of the patients was 31.3 ± 10.5 years, and the disease duration was 5.18 ± 4.1 years. 86.4% of the patients were females. Cardiac presentations by echocardiography were mainly mitral regurgitation (33.9%), tricuspid regurgitation (32.2%), mitral thickening (18.6%), aortic thickening (13.6%), pericardial effusion (13.6%), and pulmonary hypertension (8.5%) in order of frequency. The frequency of different echocardiographic findings with respect to other clinical phenotypes showed peaks with renal disease, MetS, and leukopenia. Components of MetS (triglycerides, high systolic blood pressure) and avascular necrosis were significant predictors for pericardial diseases (OR=1.011 CI 95% 1-1.022, p=0.046, OR=1.157 CI 95% 1.025-1.307, p=0.018, and OR=74.78 CI 95% 2.52-2215.76, p=0.013, respectively), and it is likely that hydroxychloroquine was protective against them. Age of the patients was a significant predictor for tricuspid regurgitation (OR=1.063 CI 95% 1.004-1.126, p=0.036). Mucosal ulcers were negative predictors for mitral thickening and regurgitation (OR=0.2 CI 95% 0.059-0.673, p=0.009). The use of corticosteroids appeared to protect against a number of valve lesions especially tricuspid regurgitation (OR=0.299 CI 95% 0.088-1.019, p=0.054). Conclusion This study highlighted different echocardiographic features and identified clinical predictors of different cardiac pathologies aiming to determine patients at risk and improve the prognosis of SLE cardiac diseases.

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“…Systemic lupus erythematosus (SLE) is a chronic inflammatory disease, which affects all organ systems [12•]. It is classified as a systemic autoimmune disease of unknown etiology, with a prevalence of 20-70 per 100,000 that is 6 times greater in women than men, and a peak onset between 15 and 40 years of age [13][14][15]. SLE is characterized by over-reactive and auto-reactive T cells, which distort normal cytokine production, resulting in increased inflammation and multi-organ tissue damage.…”

Section: Systemic Lupus Erythematosus and Antiphospholipid Syndromementioning

confidence: 99%

Disorders of the Aorta and Aortic Valve in Connective Tissue Diseases

et al. 2020

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Purpose of Review The incidence of aortic valve disease in inherited connective tissue disorders is well documented; however, recent studies have only begun to unravel the pathology behind this association. In this review, we aim to describe the etiology, clinical manifestations, management, and prognosis of aortic and aortic valvular disorders that co-exist in a variety of connective tissue diseases. An extensive literature review was performed in PubMed. Articles from 2008 to 2018 were included for review. Predetermined search terms used in PubMed include "aortic manifestation of connective tissue diseases" and "aortic valve disorders in rheumatologic disease." Recent Findings Manifestations of aortic valve disease in the context of connective tissue disorders include valvular stenosis, regurgitation, and/or thoracic aortic aneurysms. Both inherited and inflammatory connective tissue disorders contribute to aortic valve damage with increased susceptibility associated with specific gene variants. Summary Anti-inflammatory and immunosuppressive therapies have demonstrated beneficial results in Marfan's syndrome, Behcet disease, rheumatoid arthritis, ankylosing spondylitis, and systemic sclerosis, often leading to remission. Yet, such therapy is less effective in other disorders compared to alternative treatments such as surgical intervention. Additionally, regular echocardiographic studies should be recommended to those suffering from these disorders, especially those at higher risk for cardiovascular involvement. Given the rates of relapse with immunosuppressants, even following aortic valve replacement, further studies are needed to determine if certain dosing and/or combinations of immunosuppressants could be given to those diagnosed with connective tissue diseases to prevent progression of aortic valve involvement.

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Aortic valve replacement in a patient with systemic lupus erythematosus

Cited by 4 publications

References 9 publications

Acute Outcomes of Cardiac Operations in Patients With Autoimmune Disorders: A National Analysis

Acute Outcomes of Cardiac Operations in Patients With Autoimmune Disorders: A National Analysis

Cardiac Manifestations in Systemic Lupus Erythematosus: Clinical Correlates of Subclinical Echocardiographic Features

Disorders of the Aorta and Aortic Valve in Connective Tissue Diseases

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