Early and Late Outcomes Following Cardiac Surgery in Patients With Immune‐Mediated Inflammatory Diseases

BACKGROUND: Immune-mediated inflammatory diseases (IMIDs) are associated with increased cardiovascular risk, but surgical outcomes in the modern era of immunosuppressive therapy remain unclear. We evaluated early and late outcomes after cardiac and thoracic aortic surgery in patients with IMIDs, focusing on the impact of glucocorticoids and disease-modifying antirheumatic drugs (DMARDs). METHODS: A total of 140 patients with IMIDs who underwent cardiac or thoracic aortic surgery between 2008 and 2025 were retrospectively analyzed. The primary endpoints were in-hospital mortality and long-term overall survival. RESULTS: Median age was 70 [61-76] years, and 62% were women. Rheumatoid arthritis was the most common IMID (36%). Prednisolone and DMARDs were used in 68% and 33% of patients, respectively. Procedures included valve (43%), ischemic (26%), and thoracic aortic surgery (23%). In-hospital mortality was 4.3%. During a median follow-up of 5.9 years (93% completeness), overall survival was 91% at 1 year, 87% at 3 years, 78% at 5 years, and 62% at 10 years, respectively. Outcomes did not differ by a surgical category or IMID subtype. Glucocorticoid use was independently associated with worse late survival (HR, 2.91; 95% CI, 1.01-8.41; p = 0.048), whereas DMARD use showed a trend toward improved survival (HR 0.46; 95% CI, 0.19-1.09; p = 0.08). Notably, a dose-dependent relationship was observed, with high-dose prednisolone (≥ 5 mg/day) showing significantly worse survival compared with low-dose (< 5 mg/day) or no glucocorticoid use (p = 0.004). Diabetes mellitus and preoperative anemia were also independent predictors of late mortality. CONCLUSIONS: Cardiac surgery in patients with IMIDs provides acceptable early outcomes but suboptimal long-term survival. Glucocorticoid use was associated with worse late survival, with a dose-dependent relationship, whereas DMARD use showed a nonsignificant trend toward better survival, underscoring the importance of optimized immunosuppressive management.