Frontiers in cardiovascular medicine · 2025
Coronary artery bypass grafting in patients with hematological neoplasms.
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Zhang Lixue, Zhang Simeng, Jiang Hao, Liu Jian, Gao Qing, Lian Bo, Liu Zeye, Shi Yi
Аннотация
BACKGROUND: Coronary artery bypass grafting (CABG) in patients with concurrent coronary artery disease (CAD) and hematological neoplasms presents unique challenges due to immunosuppression, hematologic dysfunction, and coagulopathy. This study aimed to assess the safety and feasibility of CABG in this population and to evaluate factors influencing prognosis.
METHODS: This retrospective study included 41 patients with CAD and hematological neoplasms who underwent CABG between 2018 and 2023. Hematological neoplasms were classified into seven categories, and patients were stratified by hematological disease status: stable, disease-free, or progressive. Key perioperative outcomes, graft patency, and survival data were analyzed. Cox regression models identified independent predictors of prognosis.
RESULTS: Of the 41 patients, 28 (68.3%) were stable, 10 (24.4%) were disease-free, and 3 (7.3%) were progressive. The median preoperative platelet count was 143 × 109/L, with 8 patients presenting counts <50 × 109/L requiring preoperative platelet transfusions. Postoperative transfusion rates for packed red blood cells (PRBCs), fresh frozen plasma (FFP) and platelets were 51.2%, 39.0%, and 12.2%, respectively. The median operation time was 210 min, with 87.8% undergoing off-pump CABG. Graft patency at discharge was 92.3%. Major infections occurred in 4.9% of patients, and 9 (22%) deaths were recorded during follow-up, 8 due to hematological progression and 1 due to myocardial infarction. Cox regression identified preoperative blood cell levels as independent predictors of survival (p < 0.05), while CABG-related factors showed no significant association (p > 0.05).
CONCLUSIONS: CABG can be performed safely in most patients with stable hematological neoplasms, with no perioperative mortality, providing an opportunity for further hematological treatments. Preoperative blood cell levels significantly influence prognosis, underscoring the importance of multidisciplinary management. Larger studies are needed to validate these findings and refine treatment strategies.
METHODS: This retrospective study included 41 patients with CAD and hematological neoplasms who underwent CABG between 2018 and 2023. Hematological neoplasms were classified into seven categories, and patients were stratified by hematological disease status: stable, disease-free, or progressive. Key perioperative outcomes, graft patency, and survival data were analyzed. Cox regression models identified independent predictors of prognosis.
RESULTS: Of the 41 patients, 28 (68.3%) were stable, 10 (24.4%) were disease-free, and 3 (7.3%) were progressive. The median preoperative platelet count was 143 × 109/L, with 8 patients presenting counts <50 × 109/L requiring preoperative platelet transfusions. Postoperative transfusion rates for packed red blood cells (PRBCs), fresh frozen plasma (FFP) and platelets were 51.2%, 39.0%, and 12.2%, respectively. The median operation time was 210 min, with 87.8% undergoing off-pump CABG. Graft patency at discharge was 92.3%. Major infections occurred in 4.9% of patients, and 9 (22%) deaths were recorded during follow-up, 8 due to hematological progression and 1 due to myocardial infarction. Cox regression identified preoperative blood cell levels as independent predictors of survival (p < 0.05), while CABG-related factors showed no significant association (p > 0.05).
CONCLUSIONS: CABG can be performed safely in most patients with stable hematological neoplasms, with no perioperative mortality, providing an opportunity for further hematological treatments. Preoperative blood cell levels significantly influence prognosis, underscoring the importance of multidisciplinary management. Larger studies are needed to validate these findings and refine treatment strategies.