Our Summary

Waldenström’s Macroglobulinemia (WM) is a rare type of lymphoma where the body produces too much of a protein called immunoglobulin M (IgM). This can cause problems like thickened blood, anemia, and some specific blood disorders. The research talks about a 73-year-old man with WM who needed heart bypass surgery. This is tricky because his condition can cause complications during the operation.

The paper discusses how the doctors prepared for and carried out the operation. They used a process called plasmapheresis before the surgery, which is a technique to remove, treat, and return or replace the blood plasma. They also carefully managed the patient’s body temperature and the acid/base balance in his body. As a result, they were able to successfully perform the heart bypass surgery without many of the complications they expected due to WM.

FAQs

  1. What is Waldenström’s Macroglobulinemia and how does it affect heart surgery?
  2. What special considerations are needed when performing a cardiopulmonary bypass on a patient with Waldenström’s Macroglobulinemia?
  3. How does plasmapheresis contribute to the success of coronary artery bypass graft surgery in patients with Waldenström’s Macroglobulinemia?

Doctor’s Tip

A helpful tip a doctor might tell a patient about heart bypass surgery is to closely follow preoperative instructions, including any necessary tests or procedures such as plasmapheresis, to ensure a successful outcome. It is also important to communicate any medical conditions or medications to the medical team to help them prepare for any potential complications during surgery. Additionally, maintaining a healthy lifestyle and following postoperative care instructions, such as taking prescribed medications and attending follow-up appointments, can help ensure a smooth recovery.

Suitable For

Patients who are typically recommended for heart bypass surgery are those with severe coronary artery disease that cannot be managed with medications or other less invasive procedures. These patients may have a history of angina (chest pain), heart attacks, or other symptoms related to reduced blood flow to the heart muscle. Additionally, patients with multiple blockages in their coronary arteries, or those who have blockages in critical arteries that supply blood to a large portion of the heart muscle, may also be recommended for bypass surgery. Other factors that may influence the recommendation for bypass surgery include the patient’s overall health, age, and ability to tolerate the procedure.

Timeline

  • Before heart bypass surgery:
  1. Patient is diagnosed with coronary artery disease and recommended to undergo heart bypass surgery.
  2. Patient undergoes preoperative testing and evaluation to assess overall health and readiness for surgery.
  3. Patient with Waldenström’s Macroglobulinemia requires special considerations due to serum hyperviscosity, cold agglutinins, and cryoglobulinemia.
  4. Patient may undergo plasmapheresis to reduce levels of immunoglobulin M before surgery.
  5. Careful monitoring of anemia and other complications associated with WM is conducted.
  • After heart bypass surgery:
  1. Patient is placed on cardiopulmonary bypass during surgery.
  2. Temperature management and acid/base status are closely monitored during the procedure.
  3. Successful coronary artery bypass graft surgery is performed.
  4. Patient is monitored postoperatively for any complications related to WM or the surgery.
  5. Follow-up care includes rehabilitation and ongoing monitoring of heart health.

What to Ask Your Doctor

  1. What specific risks or complications should I be aware of due to my Waldenström’s Macroglobulinemia during heart bypass surgery?
  2. Will plasmapheresis be necessary before the surgery to reduce serum hyperviscosity?
  3. How will my anemia be managed during and after the surgery?
  4. Will the surgery impact my IgM levels or worsen my condition in any way?
  5. What measures will be taken to ensure proper temperature management during the surgery?
  6. How will my acid/base status be monitored and controlled during the surgery?
  7. Will any special precautions be taken to prevent cold agglutinins or cryoglobulinemia complications during the surgery?
  8. Are there any specific medications or treatments that should be avoided before or after the surgery due to my condition?
  9. How long is the recovery expected to be, and what follow-up care will be necessary post-surgery?
  10. Are there any lifestyle changes or precautions I should take to reduce the risk of complications following the surgery?

Reference

Authors: D’Aloiso BD, Rupchak SS, Gettle KJ, Lima C, Rush RD. Journal: J Extra Corpor Technol. 2018 Jun;50(2):120-123. PMID: 29921992