Sickle Cell Disease Patients Experience a Greater Risk of Post-Operative Complications Following Cardiac Valve Replacement Procedures: A National Database Study

R. Madera¹, I. Yan. Pesselev², K. A. Murgas³, A. Plank⁴, D. Albano⁵, A. Dhamija^6
1Stony Brook University School of Medicine, Tappan, New York ²Stony Brook, New York, New York ³Stony Brook University School of Medicine, Setauket, New York ⁴Stony Brook University School of Medicine, Stony Brook, New York ⁵Stonybrook Medical Center, Stony Brook, New York ⁶Stony Brook University, Setauket, New York

Purpose: Currently, a gap exists in the literature on the reported post-operative complications faced by the sickle cell disease (SCD) population after undergoing cardiac valve replacement surgery [1,2]. Herein, we characterize these risks so that others may consider them in their clinical decision-making for this cohort.

Methods: The data used in this retrospective cohort study was collected from the TriNetX Global Collaborative Network (with NLP), which provided access to the electronic medical records of approximately 150 million patients from 124 healthcare organizations. Using ICD-10-PCS and SNOMED codes we screened for patients in the network who underwent a cardiac valve replacement surgery, and segregated them based on those with and without a sickle-cell disorder diagnosis (ICD-10-CM-D57) in their medical records. Using TriNetX analytics, the patients from each cohort were matched based on age, sex, and race. Subsequently, we compared each cohort's risk of experiencing selected outcomes within a 30-day postoperative period (Figure 1). The data utilized in this study is a secondary analysis of existing deidentified data and therefore is exempt from our hospital institutional review board.

Results: Within TriNetX, we identified 237,011 patients who underwent cardiac valve replacement procedures, 461 (0.195%) of which had an SCD diagnosis. After propensity score matching, we assigned 453 patients to each cohort (SCD and control), all of whom were operated on in the US from 2009 through 2023. Examining the post-operative outcomes within 30 days after cardiac valve replacement procedures for each cohort, we identified statistically significant complications for which the SCD group was at a greater risk including: pericardial effusions (RR: 2.163, 95% CI: 1.246-3.755, p: 0.0048), pleural effusions (RR: 1.432, 95% CI: 1.031-1.989, p: 0.0311), endocarditis (RR: 1.509, 95% CI: 1.094-2.082, p: 0.0113), cardiac arrhythmias (RR: 1.55, 95% CI: 1.147-2.096, p: 0.0045), sepsis (RR: 2.348, 95% CI: 1.467-3.758, p: 0.0002), cerebral infarctions (RR: 2.471, 95% CI: 1.157-5.277, p: 0.0156), and acute respiratory failure (RR: 1.551, 95% CI: 1.026-2.346, p: 0.0357). Additional outcomes that did not have a significant association with either cohort are documented in Table 1.

Conclusion: Our findings demonstrate that SCD patients undergoing cardiac valve replacement experience a greater risk of serious post-operative complications. These results suggest that this patient population requires additional perioperative attention to mitigate these complications. Future studies should explore the pathological mechanisms behind these complications and strategies for their prevention.

Identify the source of the funding for this research project: N/A