Heart valve surgery in patients with homozygous sickle cell disease: A management strategy.
Loading...
Date
2015-07
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: Patients with the homozygous sickle cell disease have increased perioperative mortality. Some
indications like heart valve surgery, may justify an exchange blood transfusion to reduce the proportion of
hemoglobin S (HbS) and complications. Subjects and Methods: We report two female cases aged 20 and
27, of African origin with homozygous sickle cell anemia who underwent heart valve surgery to treat mitral
valve regurgitation. This presentation describes the perioperative considerations including anesthesia and
postoperative care. Results: A partial exchange blood transfusion decreased HbS levels from respectively,
90% and 84%, 9% to 27% and 34%, and simultaneously treated the anemia. Neither sickling crisis nor
acidosis occurred in any patient, and no special postoperative complication occurred. Average hospital stay
was 10 days. Currently, the two patients remain alive and free of cardiac symptoms. Discussion: Although
the presence of sickle cell disorders is associated with increased risk of sickling and thus vaso‑occlusive
complications, they should not be taken as a contraindication for heart valve surgery. Nevertheless, monitoring
of certain parameters such as venous, arterial oxygen content, pH, and body temperature is mandatory for
a better outcome. Furthermore, preoperative exchange transfusion has a positive influence on the outcome
of surgery and on the survival of patients undergoing heart valves surgery. Avoiding intraoperative hypoxia,
hypothermia, and vaso‑constrictive agents, minimizing HbS levels with preoperative exchange transfusion,
and ensuring a stress‑free environment with the judicious use of sedatives made surgery relatively safe in
these cases.
Description
Keywords
Exchange transfusion, Heart valve surgery, Hemoglobin, Sickle cell disease
Citation
Moutaouekkil El Mehdi, Najib Abdelmalek, Ajaja Rida, Arji Moha, Slaoui Anas. Heart valve surgery in patients with homozygous sickle cell disease: A management strategy. Annals of Cardiac Anaesthesia. 2015 Jul; 18(3): 361-366.