Impact of hepatopathy in pediatric patients after surgery for complex congenital heart disease

Abstract

Patients undergoing complex pediatric cardiac surgery in early infancy are at risk of postoperative secondary end-organ dysfunction. The aim of this study was to determine specific risk factors promoting the development of peri- and postoperative hepatopathy after surgery for congenital heart disease. In this retrospective study, we identified 20 consecutive patients operated between 2011 and 2019 from our institutional cohort who developed significant postsurgical hepatic dysfunction. These patients were compared to a control group of 30 patients with comparable initial cardiac conditions and STS-EACTS risk score. Patients who developed hepatopathy in the intensive care unit have chronic cholestasis and decreased liver synthesis. The impact of postoperative hepatopathy on morbidity was marked. In six patients (30%), liver transplantation was executed as ultima ratio, and two (10%) were listed for liver transplantation. The overall mortality related to postoperative hepatopathy is high: We found nine patients (45%) having severe hepatopathy and mostly multiple organ dysfunction who died in the postoperative course. According to risk analysis, postoperative right and left heart dysfunction in combination with a postoperative anatomical residuum needing a re-operation or re-intervention in the postoperative period is associated with a high risk for the development of cardiac hepatopathy. Furthermore, postoperative complications (pleural effusion, heart rhythm disorders, etc.), postoperative infections, and the need for parenteral nutrition also raise the risk for cardiac hepatopathy. Further investigations are needed to reduce hepatic complications and improve the general prognosis of such complex patients.

Congenital heart disease: clinical characterization in newborns from a referral hospital, Manaus, Amazonas, Brazil

“…In the pediatric population, NT-proBNP concentrations are notably elevated in individuals with complex congenital heart defects when compared to those with simple cardiac anomalies such as ASD, VSD, or PDA (FERNANDES et al, 2016). Our study's observations of increased NT-proBNP, AST, ALT, Creatinine, and GGT levels align with the literature, which not only highlights these substantial alterations in cases of CHD but also underscores their intricate relationship with hepatopathy (KEHL et al, 2021).…”

“…Furthermore, right/left heart dysfunction and the necessity for re-operation or reintervention have been identified as significant risk factors for the development of hepatopathy. These findings emphasize the imperative need for further investigations aimed at reducing hepatic complications and enhancing the prognosis of complex congenital heart disease patients (KEHL et al, 2021;XIE et al, 2021).…”

Evaluation of perioperative risk factors in pediatric patients with left ventricle outflow tract obstruction

“…Since cardiac surgery poses a traumatic risk for both heart and skeletal muscle, AST levels can rise earlier than alanine aminotransferase (ALT) levels [ 16 ]. Postoperative complications such as pleural effusion, heart rhythm disorders, postoperative infections, and the need for total parenteral nutrition also increase the risk of cardiac hepatopathy [ 17 ]. It was suggested that pediatric patients with elevated transaminases undergoing cardiac surgery are also in the high-risk group in terms of postoperative mortality [ 16 ].…”