Risks of Heart Surgery in Patients with Ankylosing Spondylitis

Surgical Issues in Patients with Ankylosing Spondylitis

Dear Doctor,
My father is 72 years old and has suffered from ankylosing spondylitis since his teenage years, which is an autoimmune disease.
He has previously taken immunomodulators.
His cervical spine is completely rigid and immobile.
Last year, he developed a bacterial infection in his heart valves, significantly damaging both the aortic and mitral valves.
Without surgical valve replacement, he is at risk of heart failure.
The issue is that the surgeon has raised several concerns:
1.
Patients with ankylosing spondylitis are at risk of fractures due to muscle relaxation during general anesthesia, so care must be taken to support his cervical or lumbar spine during surgery.
2.
Bone healing can be difficult for patients with ankylosing spondylitis, especially if part of the sternum or ribs needs to be cut.
3.
Due to the rigidity of the neck, intubation may be challenging.
We are considering surgery but are worried that these three issues could lead to surgical failure and pose a risk to his life.
From an orthopedic perspective, do you believe these three concerns could indeed be fatal risks for my father's heart surgery? If so, we would prefer not to proceed with the surgery, as it would at least eliminate the immediate risk of death from the operation.

I look forward to your response.
Thank you very much!

Miss Lin, 30~39 year old female. Ask Date: 2019/02/10

Dr. Shi Guozheng reply Orthopedics

1.
The risk of spinal fractures is higher, but with careful attention, surgery is still possible.

2.
Bone healing is generally satisfactory, and many patients have undergone total hip arthroplasty with good outcomes.

3.
Endotracheal intubation for anesthesia can be more complicated; using endoscopic intubation or, if necessary, performing a tracheostomy may be required for safety.

Reply Date: 2019/02/10

More Info

When considering heart surgery for a 72-year-old patient with ankylosing spondylitis (AS), there are several critical factors to evaluate, especially given the patient's history of autoimmune disease and recent bacterial infection of the heart valves. The concerns you've raised regarding the risks associated with anesthesia, surgical healing, and intubation are valid and warrant careful consideration.

1. Risk of Fractures Due to Muscle Relaxation: Patients with ankylosing spondylitis often have significant stiffness in their spine, particularly in the cervical region. This rigidity can lead to an increased risk of fractures during surgery, especially when muscle relaxants are used during general anesthesia. The surgical team must take extra precautions to stabilize the neck and spine during the procedure. This may involve using specialized positioning devices or supports to prevent any movement that could lead to fractures.

2. Delayed Healing of Bone: AS can affect bone healing due to the underlying inflammatory processes and potential changes in bone density. If the surgery requires cutting through the sternum or ribs, there may be concerns about how well these bones will heal postoperatively. This is particularly important in older patients, as healing rates can be slower. The surgical team should be prepared for this possibility and may consider using techniques that minimize bone disruption or employing strategies to enhance healing, such as optimizing nutrition and possibly using supplements that support bone health.

3. Difficulty with Intubation: The neck stiffness associated with AS can complicate intubation, which is necessary for general anesthesia. An anesthesiologist experienced in managing patients with limited neck mobility should be involved in the case. They may use alternative intubation techniques or equipment designed for patients with cervical spine issues. Preoperative assessment by the anesthesia team can help identify potential challenges and plan accordingly.

Given these considerations, the decision to proceed with heart surgery should involve a multidisciplinary approach. This includes collaboration between cardiologists, cardiac surgeons, anesthesiologists, and possibly orthopedic specialists who understand the implications of AS on surgical outcomes.
Risk Assessment: While the risks you've outlined are significant, they do not necessarily preclude surgery. The urgency of the heart valve replacement due to the risk of heart failure must be weighed against the potential complications of surgery. If the surgical team believes that the benefits of surgery outweigh the risks, they may recommend proceeding with the operation, provided that appropriate precautions are taken.

Alternative Options: If surgery is deemed too risky, it may be worth discussing alternative management strategies with the cardiologist. This could include medical management of heart failure symptoms, close monitoring, and possibly palliative care options if the patient's quality of life is significantly affected.

In conclusion, while the concerns regarding surgery in a patient with ankylosing spondylitis are valid, they do not automatically indicate that surgery should be avoided. A thorough evaluation by a specialized team can help mitigate risks and ensure the best possible outcome for your father. It is crucial to have an open dialogue with the healthcare providers involved to understand the risks and benefits fully and make an informed decision.

Similar Q&A

Understanding Ankylosing Spondylitis: Treatment Options and When to Consider Surgery

Hello, I was diagnosed with ankylosing spondylitis while serving in the military. My right foot swelled up, making it difficult to stand for long periods, and every step I took was painful. At that time, the doctor said I could only take steroids to relieve the pain. I also exper...

Dr. Shi Guozheng reply Orthopedics
If the hip joint is affected and medication treatment is ineffective, surgery may be considered. First, it is essential to check for the presence of arthritis, assess whether there is joint space narrowing, and determine if there is significant functional impairment before making...

Can Ankylosing Spondylitis Cause Chest Pain? Understanding Your Symptoms

I have ankylosing spondylitis and have been experiencing severe chest pain for several years. Recently, the condition has worsened, resulting in persistent overall pain that is difficult to pinpoint. Deep breathing or movements of the chest tend to exacerbate the pain. Pain relie...

Dr. Zeng Guosen reply Internal Medicine
Ankylosing spondylitis can affect the sternum and surrounding ribs, as well as other cartilage or connective tissues, leading to inflammation and pain. However, other causes of chest pain should also be ruled out. It is recommended to seek medical attention for differential diagn...

Understanding the Link Between Ankylosing Spondylitis and Vaccination

Hello Doctor, I am a 51-year-old male patient with ankylosing spondylitis. I received my first dose of the BNT vaccine in October last year and the second dose in January this year. I would like to ask if the symptoms I describe below could be related to the BNT vaccine. Since be...

Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your question. Here are my responses: 1) Is my chest pain more likely caused by the vaccine or by smoking? --> Ankylosing spondylitis can also cause chest pain, and the likelihood may be higher than the side effects from the vaccine, so it is unlikely to...

Does Medication for Ankylosing Spondylitis Cause High Blood Pressure?

Can medication for ankylosing spondylitis cause high blood pressure?

Dr. Wang Shouji reply Orthopedics
If you are unsure about the medication you are taking, you can consult the prescribing physician or ask a pharmacist directly. Thank you.