Management of patients with hematological malignancies undergoing coronary artery bypass grafting

Abstract

The number of patients with a previously diagnosed malignancy who need cardiac surgery is increasing. Patients with hematological malignancies represent only 0.38% of all patients undergoing cardiac surgery. The literature in this subset of patients is limited to only a few retrospective case series, with limited number of patients undergoing emergency cardiac surgery. We describe three cases with hematological malignancies namely chronic myelogenous leukemia, acute promyelocytic leukemia and chronic lymphocytic leukemia presenting for coronary artery bypass grafting (CABG). Two patients were taken up for emergency CABG in view of ongoing ischemia, one of them was on preoperative intra-aortic balloon pump support. No mortality was observed. Two patients needed transfusion of blood products which was guided by thromboelastography. One patient developed superficial sternal wound infection requiring antibiotic therapy.

Keywords

• Desflurane
• Myocardial protection
• OPCAB
• Sevoflurane
• Total intravenous anesthesia
• Cardiac index
• Dobutamine
• Hemodynamics
• Levosimendan
• Systemic vascular resistance index
• Cardiothoracic surgical patients
• Internal jugular vein cannulation
• Landmark-guided IJV cannulation
• Circularity index
• Coronary revascularization
• Ischemic mitral regurgitation
• Mitral valve geometry
• Nonplanarity angle
• Coronary artery bypass
• Fast-track cardiac surgery
• High thoracic epidural anesthesia
• Intraoperative monitoring
• Off-pump coronary artery bypass
• Aorto-mitral curtain
• Mitral aortic intervalvular fibrosa
• Subaortic pseudoaneurysm
• Atrial septal defect
• Coronary artery bypass surgery
• Pulmonary venous flow diastolic deceleration time
• Transesophageal echocardiography
• Acute promyelocytic leukemia (AML-M3)
• Chronic myelogenous leukemia
• Chronic lymphocytic leukemia
• Coronary artery bypass grafting
• Hematological malignancy