Long-term clinical outcomes and risk factors for the occurrence of post-operative complications after cardiovascular surgery in patients with Behçet's disease

Objective: Cardiovascular surgery in patients with Behçet's disease (BD) frequently leads to post-operative complications such as anastomotic leakage, occlusion or pseudoaneurysm. We evaluated the clinical outcomes and related risk factors of post-operative complications in BD patients undergoing cardiovascular surgeries, as well as the long-term efficiency of post-operative immunosuppressive treatment. Methods: Forty-one patients with BD who had undergone cardiovascular surgery between 1990 and 2009 were studied. We evaluated the patients' clinical data, post-operative complications, and survival rate. Risk factors related to the occurrence of post-operative complications were identified by univariate analysis using the Kaplan-Meier method with the log-rank test and multivariate analysis using the Cox proportional hazards regression model. Results: Fifty-nine operations were performed in 41 patients. During the mean follow-up period of 65.3±48.1 months, complications such as paravalvular leakage, dehiscence, fistula, graft occlusion, or pseudoaneurysm occurred in 29 operations (49.2%). The cumulative occurrence rate of postoperative complication was 10.2% at three months, 32.8% at 12 months, and 43.8% at 24 months. Upon univariate analysis, young age, high C-reactive protein levels, lack of post-operative immunosuppression, and short disease duration were identified as significant factors responsible for the occurrence of post-operative complications. In multivariate analysis, post-operative immunosuppression was found to independently lower the risk of complications. The 5-year survival rate was significantly higher in patients with post-operative immunosuppression than in those without (84.5% vs. 45.0%, p=0.011). Conclusion: The present study suggests that post-operative immunosuppressive therapy after cardiovascular surgeries in BD patients is important for reducing the development of serious post-operative complications.