Does acquired angioedema increase the risk of surgery with cardiopulmonary bypass?

Acquired angioedema is a rare condition characterized by thedeficiency of C1 inhibitor (C1-INH). This results in continuousactivation of the classical pathway, leading to consumption ofits components (C1, C2, and C4), and impairs the regulation ofthe complement and contact systems, coagulation, and fibrinol-ysis. Potentially lethal complications may ensue in suchpatients, including laryngeal edema, acute abdominal syn-dromes mimicking surgical emergencies, and hemorrhagicdiathesis.1-3Cardiopulmonary bypass (CPB) determines com-plement activation because of contact of blood with artificialsurfaces and may result in increased vascular permeability,acute pulmonary failure resembling adult respiratory distresssyndrome, multiorgan failure, and bleeding disorders.2Anecdotal reports regarding favorable2or unfavorable3out-comes after cardiac surgery are reported in the literature inpatients with acquired angioedema, but the stratification of sur-gical risk is difficult to assess because of the paucity of data.