Cardiac Surgery in Patients with Major Lower Extremity Amputation: A Single Institution Experience¹

Background: Cardiac surgery patients with lower-extremity amputations pose a challenge in terms of medical comorbidities and functional recovery. Methods: A retrospective review of all patients (n = 10) with preexisting below-knee amputation (BKA) or more proximal amputation level who underwent cardiac surgery between April 1998 and April 2008. Data were analyzed to evaluate outcomes. Results: The median age was 59 y (range, 51-75 y). One patient had bilateral above-knee amputation (AKA), and 9 had BKAs (two bilateral). Comorbidities included diabetes (n = 5), peripheral vascular disease (n = 7), cerebrovascular disease (n = 2), hypertension (n = 9), chronic renal insufficiency (n = 2), pulmonary hypertension (n = 1), and pulmonary fibrosis (n = 1). Nine patients underwent coronary artery bypass grafting and one patient underwent aortic valve replacement. There were no operative deaths. The median length of hospital stay (to home discharge) was 12.5 d (range, 5-562 d). Eight patients were transferred to a rehabilitation unit or a chronic care facility before being discharged to home. At follow-up (median, 1.5 y; range, 0.4-3.8 y), all but one patient were alive and had returned to their preoperative ambulatory status. Conclusions: In our experience, patients with lower-extremity amputations require prolonged hospitalization after cardiac surgery but can expect good mid-term outcomes and functional recovery.