Heart Valve Surgery and the Antiphospholipid Syndrome

For more than 5 decades, cardiac surgery has developed at a fast and steady pace. Since the early days of complex and cumbersome procedures initially developed at targeting the correction in congenital intracardiac defects [1, 2], all types of intra- and extracardiac procedures have been performed worldwide on a routine basis at all institutions that meet the minimum requirements for intrathoracic surgery according to international standards [3]. The lack of appropriate diagnostic tools and advanced equipment for intracardiac surgery is a stimulus for progression. The initial era of cardiac surgery was defined by the development of basic technology for diagnosis and treatment and marked by the enormous progression in clinical experience. Currently, cardiac surgery is a fully standardized specialty covering all aspects of congenital and acquired cardiovascular diseases. Up-to-date technological development combined with massive accumulation of clinical work and knowledge on intra- and postoperative management has led to an increase in the complexity and condition of the patients submitted for surgical correction of cardiac defects [4]. Antiphospholipid syndome (APS), an autoimmune disorder characterized by venous and arterial thrombosis, fetal loss, and thrombocytopenia, in the presence of antiphospholipid antibodies (aPL), namely lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or anti-b2 glycoprotein-I (b2GPI) antibodies [5], is an uncommon disease bringing difficulties in establishing an appropriate diagnosis and effective treatment. APS belongs to a formally unclassified group of uncommon or infrequent diseases such as infective endocarditis (IE). As such, a number of cases might go underdiagnosed, and, because of the specific pathophysiology, it might also pose a number of problems at the time of the management. Considering the specific impact of APS on thrombosis and hemostasis, APS is an example of a challenging disease when cardiovascular complications develop and surgical treatment is indicated. APS has been called to clinicians’ attention in recent years as patients are increasingly being diagnosed at specifically dedicated units [6] focusing on autoimmune disorders