Incidence and Prognostic Importance of Jaundice After Cardiopulmonary Bypass Surgery

Collins, J.; Ferner, Robin E; Murray, Anthony; Bassendine, Margaret F.; Blesovsky, A; Pearson, D. T.; James, Ofw

doi:10.1016/s0140-6736(83)92863-5

Cited by 99 publications

(103 citation statements)

References 15 publications

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“…This prospective study showed that the overall incidence of the postoperative hyperbilir ubinemia was 25.3%, similar to the literature report [3] . Despite advances in techniques of perioperative management in cardiac operations, CPB, and cardiac anaesthesia, early hyperbilirubinemia after modern extracorporeal circulation surgery still occurs frequently.…”

Section: Discussionsupporting

confidence: 91%

“…According to earlier studies, overall incidence of postoperative hyperbilirubinemia ranges from about 8.6% to even as high as 40% [1][2][3] . Despite improvements in perioperative management, as well as in surgical and anaesthetic techniques, early hyperbilirubinemia after modern extracorporeal circulation surgery is still seen quite often.…”

Section: Introductionmentioning

confidence: 99%

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Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

Ye²,

Zhong³

2006

WJG

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bilirubin, and is associated with a high mortality. Important contributing factors are the preoperative total bilirubin concentration, preoperative severity of right atrial pressure, numbers of valve replacement procedures, and the amount of blood transfusion requirement during and shortly after surgery. We suggest that postoperative hyperbilirubinemia is a multifactorial process, which is caused by both the impaired liver function of bilirubin transport and the increased production of bilirubin from haemolysis. INTRODUCTIONIt has long been recognized that early hyperbilirubinemia or transient jaundice could occur after extracorporeal circulation surg er y. According to earlier studies, overall incidence of postoperative hyperbilirubinemia ranges from about 8.6% to even as high as 40% [1][2][3] . Despite improvements in perioperative management, as well as in surgical and anaesthetic techniques, early hyperbilirubinemia after modern extracorporeal circulation surgery is still seen quite often. The high frequency of hyperbilirubinemia after cardiac surgery in our department prompted us to start a prospective study recently. It is aimed to clarify the incidence and nature of postoperative hyperbilir ubinemia in patients following moder n extracorporeal circulation, to analyze possible perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated mortality and morbidity. Abstract AIM: To clarify the incidence and nature of postoperative hyperbilirubinemia in patients after modern e x t r a c o r p o r e a l c i r c u l a t i o n , t o a n a l y z e p o s s i b l e perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated mortality and morbidity. MATERIALS AND METHODS Patients' backgrounds METHODS: Between March 2005 and May 2006, three hundred and eighty six consecutive patients undergoing extracorporeal circulation surgery due to a variety of cardiac lesions were investigated prospectively. The incidence of postoperative hyperbilirubinemia was defined as a serum total bilirubin concentration of more than 51 μmol/L. Several perioperative parameters w e r e c o m p a r e d b y l o g i s t i c r e g r e s s i o n b e t w e e n hyperbilirubinemia and non-hyperbilirubinemia patients to determine possible risk factors contributing to postoperative hyperbilirubinemia and mortality. R E S U LT S :O v e r a l l i n c i d e n c e o f p o s t o p e r a t i v e hyperbilirubinemia was 25.3% (98/386). In patients w i t h p o s t o p e r a t i v e h y p e r b i l i r u b i n e m i a , 5 6 . 2 % reached peak total bilirubin concentration on the first postoperative day, 33.5% on the second day, and 10.3% on the seventh day. Eighty percent of the increase of total bilirubin resulted from an increase of both conjugated and unconjugated bilirubin. Development of postoperative hyperbilirubinemia was associated with a higher mortality (P < 0.01), longer duration of mechanical ventilation (P < 0.05) and longer ICU stay ti...

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

Ye²,

Zhong³

2006

WJG

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“…Nonsurvivors presented with significantly higher preoperative bilirubin levels. Patients with hepatic dysfunction, defined as the presence of preoperative jaundice associated with an elevated serum bilirubin above 3 mg/l, experienced a much higher mortality rate compared with the control group [23,24]. In patients with end-stage cardiac failure requiring ventricular assist device, a low preoperative bilirubin level has been shown to be the only significant predictor for survival [25].…”

Section: Discussionmentioning

confidence: 99%

Open-heart surgery in patients with liver cirrhosis

Zhong

2007

European Journal of Cardio-Thoracic Surgery

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Background: This retrospective study was designed to examine morbidity and mortality rates and to find predictors of outcome in patients with liver cirrhosis (LC) undergoing open-heart surgery. Methods: Between May 1996 and June 2005, 24 patients with LC underwent an open-heart surgery in our institution. Results: There were 14 females and 10 males. Their age ranged from 36 to 72 (average 53 AE 13) years. Seventeen cases were classified as having Child-Pugh class A cirrhosis, six as having class B cirrhosis, and one as having class C cirrhosis. The mean cardiopulmonary bypass (CPB) time and the cross-clamp time were 160 AE 53 and 90 AE 42 min, respectively. In the first 24 h after operation, the mean chest tube output was 1080 AE 320 ml. Mean duration of mechanical ventilation was 32 AE 22 h and mean intensive care unit stay time was 11 AE 8 days. Sixtysix percent of the patients experienced significant morbidity. Fifty-three percent of patients with class A cirrhosis and 100% of those with class B and C cirrhosis suffered postoperative complications. The overall mortality rate was 25%. Postoperative mortality of patients with Child-Pugh class A cirrhosis, class B cirrhosis, and C cirrhosis were 6, 67, and 100%, respectively. Preoperative serum total bilirubin (TB), cholinesterase (ChE), and CPB time were defined as predictors to differentiate survivors and nonsurvivors. Conclusion: Child-Pugh class is related to morbidity and mortality after open-heart surgery in patients with LC. But CPB surgery is associated with higher morbidity and mortality in patients with advanced LC. The increased serum level of TB and the low serum concentration of ChE preoperatively, and the prolonged CPB time were found to be predictors of outcome in patients with LC undergoing open heart surgery. #

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“…Incidence of hyperbilirubinemia after cardiac surgery ranging 20% to 35,1% in last two decade studies. Postoperative hyperbilirubinemia due to liver dysfunction is associated with morbidity and mortality (1,2). Recently, Horsfall et al reported a negative association of bilirubin with cardiovascular events and death in both men and women (6) .…”

Section: Di̇scussi̇onmentioning

confidence: 99%

Koroner Arter By-Pass Cerrahisi Sonrası Gelişen Şiddetli Hiperbilirubinemi Vakası

Yılmaz

Ekim

Turan³

et al. 2015

J Contemp Med

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Kardiyak cerrahi sonrası postoperatif hiperbilirubineminin sıklığı ve paterni ile komlikasyonları iyi tanımlanmamıştır. Karaciğer disfonksiyonuna bağlı postoperatif hiperbilirubinemi, artan morbidite ve mortalite ile ilişkili olabilir. Biz burada koroner arter bypass cerrahisi sonrası yapılan ekokardiyografide sağ ventrikül kollapsı ve perikardiyal hematom saptanan ve hematom boşaltılması sonucu hemodinamik tablosu düzelen hastayı sunduk. Hastanın total ve direkt bilirubin seviyeleri reoperasyonun birinci gününde, sırasıyla 8,3 mg/dl ve 2,3 mg/ dl ye yükseldi. Takipte altıncı günde bilirubin seviyesi maksimum 23.1 mg/dl'ye yükseldi. Ultrasonografide hepatik doku ve bilirubin kanalları normal olarak değerlendirildi. Alanin aminotransferaz (ALT), aspartat aminotransferaz (AST) ve gama glutamil transferaz (GGT) gibi hepatik fonksiyon testleri normal olan hastaya spesifik bir tedavi verilmeden hiperbilirubinemi normal değerlere geriledi.Anahtar sözcükler: Koroner arter bypass, hiperbilirubinemi, karaciğer fonksiyon testleri.The pattern and frequency of hyperbilirubinemia after cardiac surgery and its effect on postoperative complications are not well described. Postoperative hyperbilirubinemia due to liver dysfunction may be associated with increased morbidity and mortality. We present a 60-year-old male patient that we detected pericardial hematoma and collapsed right ventricle after the coronary artery bypass surgery. Patient's clinical status was improved after the operation for evacuating hematoma. Total bilirubin and direct bilirubin levels of patient were increased up to 8,3 mg/dl and 2,3 mg/dl respectively in the first day of re-operation. In follow up, bilirubin level reached to a maximum level of 23.1 mg/dl on sixth day. In ultrasonography hepatic tissue and bilirubin tract were normal. Hepatic function tests except bilirubin such as alanin aminotransferaz (ALT), aspartat aminotransferaz (AST) and gama glutamil transferaz (GGT) were in normal level. Hyperbilirubinemia resolved spontaneously without any specific treatment.

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Incidence and Prognostic Importance of Jaundice After Cardiopulmonary Bypass Surgery

Cited by 99 publications

References 15 publications

Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

Open-heart surgery in patients with liver cirrhosis

Koroner Arter By-Pass Cerrahisi Sonrası Gelişen Şiddetli Hiperbilirubinemi Vakası

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