Clinical efficacy of cardiovascular surgery combined with preoperative immunosuppression for Behcet's disease: A retrospective cohort study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Fanyu ¹ , YE Lanxin ² , XU Ziyan ³ , CHEN Oudi ⁴ , GAN Lixi ² , QING Hongkun ¹ , WANG Weiteng ² , LI Xin ¹ , CUI Yang ⁵ ,  JIAN Xuhua ¹

1. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, South Medical University, Guangzhou, 510010, P. R. China;
2. Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510010, P. R. China;
3. The Second Medical College of South Medical University, Guangzhou, 510280, P. R. China;
4. Department of Echocardiography, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, South Medical University, Guangzhou, 510010, P. R. China;
5. Department of Rheumatology and Immunology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, South Medical University, Guangzhou, 510010, P. R. China;

Corresponding author：

JIAN Xuhua, Email: jianxuhua@gdph.org.cn

Keywords：

Behçet’s disease; cardiac surgery; immunosuppression; complications; survival rate

DOI：

10.7507/1007-4848.202407059

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Objective To evaluate the effectiveness of preoperative immunosuppressive therapy combined with surgical intervention. Methods A retrospective study was conducted on Behçet's disease patients who underwent cardiac surgery at Guangdong Provincial People's Hospital from 2012 to 2021. Patients were divided into immunosuppressive group and non-immunosuppressive group based on whether they received immunosuppressive therapy before surgery. The complications and long-term survival rates of the two groups were analyzed. Results A total of 28 patients were included, among which 2 patients underwent reoperation, a total of 30 surgeries were performed, including 16 males (53.3%), and the confirmed age was 37 (31, 45) years old. There were 15 surgeries in the immunosuppressive group and 15 surgeries in the non-immunosuppressive group. Compared with the non-immunosuppressive group, the incidence of complications during hospitalization in the immunosuppressive group was lower (13.3% vs. 53.3%, P=0.008). One patient died in hospital, and the rest were discharged and followed up, with a median follow-up time of 38.7 (15.1, 57.3) months, and there was no statistically significant difference in long-term survival rate between the two groups (26.7% vs. 6.7%, P=0.158). There was no statistically significant difference in the cumulative incidence of complications one month (20% vs. 53%, P=0.058) and one year (27% vs. 60%, P=0.065) after surgery between the immunosuppressive group and the non-immunosuppressive group, but there was a statistically significant difference in the cumulative incidence of complications three years after surgery (47% vs. 92%, P=0.002). Conclusion Surgical treatment can save lives in Behçet's disease patients with cardiovascular diseases, but the incidence of postoperative complications is high. Timely use of immunosuppressants before cardiovascular surgery can reduce the incidence of postoperative complications.

1.	Behcet H. Uber rezidiverende aphthose durch ein virus verursachte geschwure am mund, am auge und an den genitalien. 1937.
2.	Sakane T, Takeno M, Suzuki N, et al. Behçet's disease. N Engl J Med, 1999, 341(17): 1284-1291.
3.	Park MC, Hong BK, Kwon HM, et al. Surgical outcomes and risk factors for postoperative complications in patients with Behcet's disease. Clin Rheumatol, 2007, 26(9): 1475-1480.
4.	代明辉, 帅晓, 吴俣. 以多发静脉血栓为首发表现的骨髓增生异常综合征伴白塞病一例. 华西医学, 2023, 38(1): 147-150.
5.	Ro SS, Hashemi S, Shaw F, et al. Diagnostic approach to recurrent intracardiac masses that present with systemic symptoms. Pediatrics, 2023, 152(5): e2023062122.
6.	Owlia MB, Mehrpoor G. Behcet's disease: New concepts in cardiovascular involvements and future direction for treatment. ISRN Pharmacol, 2012, 2012: 760484.
7.	El Bhali H, Zahdi O, Bakkali T, et al. False aneurysm of the abdominal aorta revealing Behçet's disease. J Med Vasc, 2019, 44(5): 344-349.
8.	Asmar N, Geerlinks AV, Laxer RM, et al. Recurrent oral ulcerations following heart transplant in a pediatric patient: A diagnostic dilemma. Pediatr Transplant, 2018, 22(7): e13264.
9.	Takayama T, Ozawa T, Sanada A, et al. Aortic Regurgitation Presenting with Recurrent Detachment of a Prosthetic Valve, as the First Presenting Symptom of Cardiovascular Behçet's Disease. Intern Med, 2018, 57(6): 823-827.
10.	Hatemi G, Christensen R, Bang D, et al. 2018 update of the EULAR recommendations for the management of Behçet's syndrome. Ann Rheum Dis, 2018, 77(6): 808-818.
11.	International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). The International Criteria for Behçet's Disease (ICBD): A collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol, 2014, 28(3): 338-347.
12.	Suzuki Kurokawa M, Suzuki N. Behcet's disease. Clin Exp Med, 2004, 4(1): 10-20.
13.	Pu L, Li R, Xie J, et al. Characteristic Echocardiographic Manifestations of Behçet's Disease. Ultrasound Med Biol, 2018, 44(4): 825-830.
14.	Lee I, Park S, Hwang I, et al. Cardiac Behçet disease presenting as aortic valvulitis/aortitis or right heart inflammatory mass: A clinicopathologic study of 12 cases. Am J Surg Pathol, 2008, 32(3): 390-398.
15.	Jeong DS, Kim KH, Kim JS, et al. Long-term experience of surgical treatment for aortic regurgitation attributable to Behçet's disease. Ann Thorac Surg, 2009, 87(6): 1775-1782.
16.	Guo X, Tian Z, Liu Y, et al. Preoperative immunosuppressive therapy reduces paravalvular leakage after aortic valve surgery in patients with aortic regurgitation attributable to Behçet's disease. Clin Exp Rheumatol, 2016, 34(6 Suppl 102): S26-S33.
17.	Choi JH, Seo HS. Huge coronary artery aneurysm causing myocardial infarction in Behcet disease. Eur Heart J Cardiovasc Imaging, 2019, 20(9): 1071.
18.	Chen J, Liang HN, Wu L, et al. Right sinus of Valsalva aneurysm spontaneously dissecting into the interventricular septum in a rare case of Behcet's disease. Eur Heart J Cardiovasc Imaging, 2019, 20(5): 601.
19.	Maaroufi AA, Abouradi SS, Hayar SS, et al. Giant right ventricular thrombus as the revealing form of Behçet's disease. Egypt Heart J, 2023, 75(1): 27.
20.	Xue Y, Pan J, Zhou Q, et al. Clinical experience of aortic valve surgery in patients with aortitis disease. Heart Surg Forum, 2019, 22(5): E366-E371.
21.	Vural U, Kizilay M, Aglar AA. Coronary involvement in Behçet's disease: What are its risks and prognosis? (rare cases and literature review). Braz J Cardiovasc Surg, 2019, 34(6): 749-758.
22.	Karadag O, Bolek EC. Management of Behcet's syndrome. Rheumatology (Oxford), 2020, 59(Suppl 3): iii108-iii117.
23.	Sun X, Yuan L, Liu J, et al. The surgical outcomes of aortic valve replacement in patients with aortic valve lesions caused by Behcet's disease: Lessons we learned. Ann Transl Med, 2021, 9(20): 1607.
24.	Choi HM, Kim HK, Park SJ, et al. Predictors of paravalvular aortic regurgitation after surgery for Behcet's disease-related severe aortic regurgitation. Orphanet J Rare Dis, 2019, 14(1): 132.
25.	Ando M, Kosakai Y, Okita Y, et al. Surgical treatment for aortic regurgitation caused by Takayasu's arteritis. J Card Surg, 1998, 13(3): 202-207.
26.	Song JK, Kim MJ, Kim DH, et al. Factors determining outcomes of aortic valve surgery in patients with aortic regurgitation due to Behçet's disease: Impact of preoperative echocardiographic features. J Am Soc Echocardiogr, 2011, 24(9): 995-1003.

1. Behcet H. Uber rezidiverende aphthose durch ein virus verursachte geschwure am mund, am auge und an den genitalien. 1937.
2. Sakane T, Takeno M, Suzuki N, et al. Behçet's disease. N Engl J Med, 1999, 341(17): 1284-1291.
3. Park MC, Hong BK, Kwon HM, et al. Surgical outcomes and risk factors for postoperative complications in patients with Behcet's disease. Clin Rheumatol, 2007, 26(9): 1475-1480.
4. 代明辉, 帅晓, 吴俣. 以多发静脉血栓为首发表现的骨髓增生异常综合征伴白塞病一例. 华西医学, 2023, 38(1): 147-150.
5. Ro SS, Hashemi S, Shaw F, et al. Diagnostic approach to recurrent intracardiac masses that present with systemic symptoms. Pediatrics, 2023, 152(5): e2023062122.
6. Owlia MB, Mehrpoor G. Behcet's disease: New concepts in cardiovascular involvements and future direction for treatment. ISRN Pharmacol, 2012, 2012: 760484.
7. El Bhali H, Zahdi O, Bakkali T, et al. False aneurysm of the abdominal aorta revealing Behçet's disease. J Med Vasc, 2019, 44(5): 344-349.
8. Asmar N, Geerlinks AV, Laxer RM, et al. Recurrent oral ulcerations following heart transplant in a pediatric patient: A diagnostic dilemma. Pediatr Transplant, 2018, 22(7): e13264.
9. Takayama T, Ozawa T, Sanada A, et al. Aortic Regurgitation Presenting with Recurrent Detachment of a Prosthetic Valve, as the First Presenting Symptom of Cardiovascular Behçet's Disease. Intern Med, 2018, 57(6): 823-827.
10. Hatemi G, Christensen R, Bang D, et al. 2018 update of the EULAR recommendations for the management of Behçet's syndrome. Ann Rheum Dis, 2018, 77(6): 808-818.
11. International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). The International Criteria for Behçet's Disease (ICBD): A collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol, 2014, 28(3): 338-347.
12. Suzuki Kurokawa M, Suzuki N. Behcet's disease. Clin Exp Med, 2004, 4(1): 10-20.
13. Pu L, Li R, Xie J, et al. Characteristic Echocardiographic Manifestations of Behçet's Disease. Ultrasound Med Biol, 2018, 44(4): 825-830.
14. Lee I, Park S, Hwang I, et al. Cardiac Behçet disease presenting as aortic valvulitis/aortitis or right heart inflammatory mass: A clinicopathologic study of 12 cases. Am J Surg Pathol, 2008, 32(3): 390-398.
15. Jeong DS, Kim KH, Kim JS, et al. Long-term experience of surgical treatment for aortic regurgitation attributable to Behçet's disease. Ann Thorac Surg, 2009, 87(6): 1775-1782.
16. Guo X, Tian Z, Liu Y, et al. Preoperative immunosuppressive therapy reduces paravalvular leakage after aortic valve surgery in patients with aortic regurgitation attributable to Behçet's disease. Clin Exp Rheumatol, 2016, 34(6 Suppl 102): S26-S33.
17. Choi JH, Seo HS. Huge coronary artery aneurysm causing myocardial infarction in Behcet disease. Eur Heart J Cardiovasc Imaging, 2019, 20(9): 1071.
18. Chen J, Liang HN, Wu L, et al. Right sinus of Valsalva aneurysm spontaneously dissecting into the interventricular septum in a rare case of Behcet's disease. Eur Heart J Cardiovasc Imaging, 2019, 20(5): 601.
19. Maaroufi AA, Abouradi SS, Hayar SS, et al. Giant right ventricular thrombus as the revealing form of Behçet's disease. Egypt Heart J, 2023, 75(1): 27.
20. Xue Y, Pan J, Zhou Q, et al. Clinical experience of aortic valve surgery in patients with aortitis disease. Heart Surg Forum, 2019, 22(5): E366-E371.
21. Vural U, Kizilay M, Aglar AA. Coronary involvement in Behçet's disease: What are its risks and prognosis? (rare cases and literature review). Braz J Cardiovasc Surg, 2019, 34(6): 749-758.
22. Karadag O, Bolek EC. Management of Behcet's syndrome. Rheumatology (Oxford), 2020, 59(Suppl 3): iii108-iii117.
23. Sun X, Yuan L, Liu J, et al. The surgical outcomes of aortic valve replacement in patients with aortic valve lesions caused by Behcet's disease: Lessons we learned. Ann Transl Med, 2021, 9(20): 1607.
24. Choi HM, Kim HK, Park SJ, et al. Predictors of paravalvular aortic regurgitation after surgery for Behcet's disease-related severe aortic regurgitation. Orphanet J Rare Dis, 2019, 14(1): 132.
25. Ando M, Kosakai Y, Okita Y, et al. Surgical treatment for aortic regurgitation caused by Takayasu's arteritis. J Card Surg, 1998, 13(3): 202-207.
26. Song JK, Kim MJ, Kim DH, et al. Factors determining outcomes of aortic valve surgery in patients with aortic regurgitation due to Behçet's disease: Impact of preoperative echocardiographic features. J Am Soc Echocardiogr, 2011, 24(9): 995-1003.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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