Influence of systemic lupus erythematosus on procedure selection and outcomes of patients undergoing isolated mitral valve surgery

Abstract

Background: Cardiovascular disease is the main cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). SLE as a risk factor for adverse outcomes during mitral surgery has not been studied. The purpose of this investigation was to compare procedure selection and outcomes of patients with and without SLE.

Methods: The 2005-2008 Nationwide Inpatient Sample database was searched to identify patients ≥18 years of age undergoing isolated mitral repair or replacement. Patients with and without SLE were compared on baseline characteristics and hospital outcomes. Within patients with SLE, those undergoing repair and replacement were compared.

Results: SLE patients comprised 0.9% (620/70,969) of the isolated mitral valve surgery population. Patients with SLE were significantly younger, more likely to be female, less likely to be white, had higher Charlson comorbidity index, and less often presented electively. Patients with SLE had a higher incidence of prolonged hospitalization (LOS > 10 days; 44.4% vs. 34.7%, p = 0.0392). Mortality was similar for patients with and without SLE undergoing isolated mitral valve surgery (OR = 0.76, 95% CI 0.28-2.05, p = 0.5821). Patients with SLE were less likely to have mitral valve repair (27.1% vs. 45.6%, p = 0.0002). Baseline characteristics were similar between SLE repair and replacement subsets. Median LOS was higher for replacement (10 days vs. 7 days, p = 0.0014). Hospital mortality was 0% for SLE mitral repair patients and <4.0% for SLE replacement patients.

Conclusions: Patients with SLE present for isolated mitral valve surgery at a much younger age and with worse preoperative profiles. Although mitral repair rates were lower in patients with SLE, hospital outcomes were excellent, and comparable to those of patients without SLE.