Impact of high titre of antiphospholipid antibodies on postoperative outcome following pulmonary endarterectomy

Andrea Maria D'Armini, Pasquale Totaro, Salvatore Nicolardi, Marco Morsolini, Giuseppe Silvaggio, Francesca Toscano, Michele Toscano, Mario Viganò

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: Antiphospholipid (a-PL) antibodies, especially IgG isotype, have been associated with a variety of neurological manifestations related to thrombotic mechanism and reactivity against nervous tissues. Furthermore, high titre of a-PL antibodies has been also correlated to chronic thromboembolic pulmonary hypertension (CTEPH) and, therefore, is frequently reported in patients undergoing pulmonary endarterectomy (PEA). The impact of a-PL antibodies in postoperative outcome following PEA, however, has not been clearly evaluated yet. In this paper, we investigated the impact of a high a-PL IgG titre (HAPT) on postoperative outcome following PEA. Methods: From April 1994 to October 2008, out of 204 patients undergoing PEA at our centre, 184 were prospectively screened for a-PL antibodies. According to the preoperative IgG titre, patients were divided into two groups: Group A (high a-PL antibodies titre - HAPT) with a-PL IgG titre >10 U/ml and Group B (low a-PL antibodies titre - LAPT) with a-PL IgG titre ≤10 U/ml. Early outcomes were compared between the two groups. Results: Twenty-eight patients (15%) were included in Group A, whereas 156 (85%) patients were included in Group B. HAPT influenced preoperative parameters as patients of Group A were younger compared to those of Group B (42±16 and 52±16 for Group A and B, respectively, P=0.001) and presented more frequently a previous history of deep venous thrombosis (DVT) (96% and 62% for Group A and B, respectively, P=0.001). The two groups were homogeneous for all other operative parameters. As far as postoperative outcome, in terms of mortality and major complications, there were no differences between the two groups. Incidence of transient neurological complications, however, was significantly different (32% and 10% for Group A and B, respectively, P=0.023). Conclusions: The presence of high titre of IgG isotype a-PL antibodies significantly influences preoperative characteristics of patients undergoing PEA. Furthermore, despite that no significant differences were shown in major end points, the presence of high titre of a-PL did interfere with postoperative course as caused by an increased rate of minor and transient neurological impairment (TNI). An accurate monitoring especially during hypothermic circulatory arrest (CA) period seems, therefore, mandatory in this subgroup of patients undergoing PEA.

Original languageEnglish
Pages (from-to)418-422
Number of pages5
JournalInteractive Cardiovascular and Thoracic Surgery
Volume10
Issue number3
DOIs
Publication statusPublished - Mar 2010

Fingerprint

Endarterectomy
Antiphospholipid Antibodies
Immunoglobulin G
Lung
Nerve Tissue
Neurologic Manifestations
Pulmonary Hypertension
Venous Thrombosis
Mortality
Incidence

Keywords

  • Antiphospholipid syndrome
  • Cerebral protection
  • Pulmonary endarterectomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Impact of high titre of antiphospholipid antibodies on postoperative outcome following pulmonary endarterectomy. / D'Armini, Andrea Maria; Totaro, Pasquale; Nicolardi, Salvatore; Morsolini, Marco; Silvaggio, Giuseppe; Toscano, Francesca; Toscano, Michele; Viganò, Mario.

In: Interactive Cardiovascular and Thoracic Surgery, Vol. 10, No. 3, 03.2010, p. 418-422.

Research output: Contribution to journalArticle

@article{69ab27171c0042d7a733a30cd17d8e70,
title = "Impact of high titre of antiphospholipid antibodies on postoperative outcome following pulmonary endarterectomy",
abstract = "Objective: Antiphospholipid (a-PL) antibodies, especially IgG isotype, have been associated with a variety of neurological manifestations related to thrombotic mechanism and reactivity against nervous tissues. Furthermore, high titre of a-PL antibodies has been also correlated to chronic thromboembolic pulmonary hypertension (CTEPH) and, therefore, is frequently reported in patients undergoing pulmonary endarterectomy (PEA). The impact of a-PL antibodies in postoperative outcome following PEA, however, has not been clearly evaluated yet. In this paper, we investigated the impact of a high a-PL IgG titre (HAPT) on postoperative outcome following PEA. Methods: From April 1994 to October 2008, out of 204 patients undergoing PEA at our centre, 184 were prospectively screened for a-PL antibodies. According to the preoperative IgG titre, patients were divided into two groups: Group A (high a-PL antibodies titre - HAPT) with a-PL IgG titre >10 U/ml and Group B (low a-PL antibodies titre - LAPT) with a-PL IgG titre ≤10 U/ml. Early outcomes were compared between the two groups. Results: Twenty-eight patients (15{\%}) were included in Group A, whereas 156 (85{\%}) patients were included in Group B. HAPT influenced preoperative parameters as patients of Group A were younger compared to those of Group B (42±16 and 52±16 for Group A and B, respectively, P=0.001) and presented more frequently a previous history of deep venous thrombosis (DVT) (96{\%} and 62{\%} for Group A and B, respectively, P=0.001). The two groups were homogeneous for all other operative parameters. As far as postoperative outcome, in terms of mortality and major complications, there were no differences between the two groups. Incidence of transient neurological complications, however, was significantly different (32{\%} and 10{\%} for Group A and B, respectively, P=0.023). Conclusions: The presence of high titre of IgG isotype a-PL antibodies significantly influences preoperative characteristics of patients undergoing PEA. Furthermore, despite that no significant differences were shown in major end points, the presence of high titre of a-PL did interfere with postoperative course as caused by an increased rate of minor and transient neurological impairment (TNI). An accurate monitoring especially during hypothermic circulatory arrest (CA) period seems, therefore, mandatory in this subgroup of patients undergoing PEA.",
keywords = "Antiphospholipid syndrome, Cerebral protection, Pulmonary endarterectomy",
author = "D'Armini, {Andrea Maria} and Pasquale Totaro and Salvatore Nicolardi and Marco Morsolini and Giuseppe Silvaggio and Francesca Toscano and Michele Toscano and Mario Vigan{\`o}",
year = "2010",
month = "3",
doi = "10.1510/icvts.2009.221630",
language = "English",
volume = "10",
pages = "418--422",
journal = "Interactive Cardiovascular and Thoracic Surgery",
issn = "1569-9293",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "3",

}

TY - JOUR

T1 - Impact of high titre of antiphospholipid antibodies on postoperative outcome following pulmonary endarterectomy

AU - D'Armini, Andrea Maria

AU - Totaro, Pasquale

AU - Nicolardi, Salvatore

AU - Morsolini, Marco

AU - Silvaggio, Giuseppe

AU - Toscano, Francesca

AU - Toscano, Michele

AU - Viganò, Mario

PY - 2010/3

Y1 - 2010/3

N2 - Objective: Antiphospholipid (a-PL) antibodies, especially IgG isotype, have been associated with a variety of neurological manifestations related to thrombotic mechanism and reactivity against nervous tissues. Furthermore, high titre of a-PL antibodies has been also correlated to chronic thromboembolic pulmonary hypertension (CTEPH) and, therefore, is frequently reported in patients undergoing pulmonary endarterectomy (PEA). The impact of a-PL antibodies in postoperative outcome following PEA, however, has not been clearly evaluated yet. In this paper, we investigated the impact of a high a-PL IgG titre (HAPT) on postoperative outcome following PEA. Methods: From April 1994 to October 2008, out of 204 patients undergoing PEA at our centre, 184 were prospectively screened for a-PL antibodies. According to the preoperative IgG titre, patients were divided into two groups: Group A (high a-PL antibodies titre - HAPT) with a-PL IgG titre >10 U/ml and Group B (low a-PL antibodies titre - LAPT) with a-PL IgG titre ≤10 U/ml. Early outcomes were compared between the two groups. Results: Twenty-eight patients (15%) were included in Group A, whereas 156 (85%) patients were included in Group B. HAPT influenced preoperative parameters as patients of Group A were younger compared to those of Group B (42±16 and 52±16 for Group A and B, respectively, P=0.001) and presented more frequently a previous history of deep venous thrombosis (DVT) (96% and 62% for Group A and B, respectively, P=0.001). The two groups were homogeneous for all other operative parameters. As far as postoperative outcome, in terms of mortality and major complications, there were no differences between the two groups. Incidence of transient neurological complications, however, was significantly different (32% and 10% for Group A and B, respectively, P=0.023). Conclusions: The presence of high titre of IgG isotype a-PL antibodies significantly influences preoperative characteristics of patients undergoing PEA. Furthermore, despite that no significant differences were shown in major end points, the presence of high titre of a-PL did interfere with postoperative course as caused by an increased rate of minor and transient neurological impairment (TNI). An accurate monitoring especially during hypothermic circulatory arrest (CA) period seems, therefore, mandatory in this subgroup of patients undergoing PEA.

AB - Objective: Antiphospholipid (a-PL) antibodies, especially IgG isotype, have been associated with a variety of neurological manifestations related to thrombotic mechanism and reactivity against nervous tissues. Furthermore, high titre of a-PL antibodies has been also correlated to chronic thromboembolic pulmonary hypertension (CTEPH) and, therefore, is frequently reported in patients undergoing pulmonary endarterectomy (PEA). The impact of a-PL antibodies in postoperative outcome following PEA, however, has not been clearly evaluated yet. In this paper, we investigated the impact of a high a-PL IgG titre (HAPT) on postoperative outcome following PEA. Methods: From April 1994 to October 2008, out of 204 patients undergoing PEA at our centre, 184 were prospectively screened for a-PL antibodies. According to the preoperative IgG titre, patients were divided into two groups: Group A (high a-PL antibodies titre - HAPT) with a-PL IgG titre >10 U/ml and Group B (low a-PL antibodies titre - LAPT) with a-PL IgG titre ≤10 U/ml. Early outcomes were compared between the two groups. Results: Twenty-eight patients (15%) were included in Group A, whereas 156 (85%) patients were included in Group B. HAPT influenced preoperative parameters as patients of Group A were younger compared to those of Group B (42±16 and 52±16 for Group A and B, respectively, P=0.001) and presented more frequently a previous history of deep venous thrombosis (DVT) (96% and 62% for Group A and B, respectively, P=0.001). The two groups were homogeneous for all other operative parameters. As far as postoperative outcome, in terms of mortality and major complications, there were no differences between the two groups. Incidence of transient neurological complications, however, was significantly different (32% and 10% for Group A and B, respectively, P=0.023). Conclusions: The presence of high titre of IgG isotype a-PL antibodies significantly influences preoperative characteristics of patients undergoing PEA. Furthermore, despite that no significant differences were shown in major end points, the presence of high titre of a-PL did interfere with postoperative course as caused by an increased rate of minor and transient neurological impairment (TNI). An accurate monitoring especially during hypothermic circulatory arrest (CA) period seems, therefore, mandatory in this subgroup of patients undergoing PEA.

KW - Antiphospholipid syndrome

KW - Cerebral protection

KW - Pulmonary endarterectomy

UR - http://www.scopus.com/inward/record.url?scp=77649297824&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77649297824&partnerID=8YFLogxK

U2 - 10.1510/icvts.2009.221630

DO - 10.1510/icvts.2009.221630

M3 - Article

VL - 10

SP - 418

EP - 422

JO - Interactive Cardiovascular and Thoracic Surgery

JF - Interactive Cardiovascular and Thoracic Surgery

SN - 1569-9293

IS - 3

ER -