Aims: Thrombophilic diathesis may cause severe problems in cardiac surgical patients. Protein
S deficiency is a coagulation disorder associated with recurrent thromboembolic events.
We analysed our experience with seven patients with protein S deficiency who underwent
cardiac surgery between 1999 and 2005.
Methods: We retrospectively reviewed the clinical data, operative and postoperative courses,
and the mid-term results of seven patients who were diagnosed to have protein S deficiency.
In three of them, a past medical history of thromboembolic events and subsequent laboratory
screening lead to the preoperative diagnosis of protein S deficiency. Four patients
were diagnosed perioperatively after a thromboembolic event. Six of the patients were
operated using cardiopulmonary bypass, one was operated off-pump.
Results: Procedures performed were emergent pulmonary embolectomy (patient 1), aortic valve
replacement and coronary artery bypass grafting (CABG, patient 2), Re-CABG (patients
3 and 7) and CABG (patients 4, 5 and 6). Patients 4, 5 and 6 had known protein S deficiency
and underwent cardiac surgery under continous coumadin therapy. At follow up (mean
follow up of 12±17 months), all but one patient were on continous coumadin, well and
without any further thromboembolic events.
Conclusions: In case of a past medical history of thromboembolic events we suggest careful laboratory
screening to identify an underlying thrombophilic disorder. We then operate the patient
under coumadin therapy with a target INR of 2.0, in order to minimize the risk of
perioperative thromboembolism. Though rare, protein S deficiency and other coagulation
disorders can be a critical issue in cardiac surgery.
