Lymphatic cardiac tamponade after open-heart surgery with liver dysfunction

Kawahira, Toshihiro; Wakita, Noboru; Minami, Hiroya; Sakata, Masahiro; Kitano, Ikuro; Shida, Tsutomu

doi:10.1007/s11748-003-0007-6

Cited by 4 publications

(5 citation statements)

References 6 publications

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“…The mortality can reach 85%-90% once the postoperative jaundice progresses to hepatic failure [4][5][6][7] . On the other hand, for patients with preoperative cirrhosis of liver, mortality of CPB surgery can reach 31% [8] .…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

Ye²,

Zhong³

2006

WJG

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“…The institution of cardiopulmonary bypass (CPB) in open cardiac surgery is associated with some body organ dysfunction. 1 As the number of patients undergoing cardiac surgery is increased need to CPB is also increased. CPB is non physiologic circulation and the patients are subjected to a various degree of body organ dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“…CPB is non physiologic circulation and the patients are subjected to a various degree of body organ dysfunction. 1 , 2 The careful recent medical literature review revealed that most studies have been focused on methods to protect organs from adverse effect of CPB; however, most of these studies missed evaluation of the liver function and focused on organs such as heart, lung and kidney. Paparella et al 3 showed that in the high-risk cardiac surgery, about 10% of patients who received CPB, experience hepatic injury, which directly affects morbidity and mortality of patients.…”

Section: Introductionmentioning

confidence: 99%

Liver Function Tests Following Open Cardiac Surgery

Sabzi¹,

Faraji²

2015

J Cardiovasc Thorac Res

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Introduction: The cardiopulmonary bypass may have multiple systemic effects on the body organs as liver. This prospective study was planned to explore further the incidence and significance of this change. Methods: Two hundred patients with coronary artery bypass grafting (CABG), were randomly selected for the study. Total and indirect bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase were measured preoperatively and at 24, 48 and 72 hours, following coronary artery bypass grafting. Postoperative value of the liver function tests with respect to hypothermia or hypotension were compared by one way analysis of variance for repeated measure and compared with t test. Patient’s characteristics with bilirubin value (≤1.5 mg or >1.5 mg) were compared with t test. Results: A significant increase of total bilirubin, aspartate aminotransferase, and alkaline phosphatase were noted in the third postoperative day. Significant relation was seen between hypotension and alkaline phosphatase, and aspartate aminotransferase change but hypothermia had not affected alanine aminotransferase, total bilirubin and indirect bilirubin change. Pump time, alanine aminotransferase in third postoperative day and direct bilirubin in first and second day of postoperative period had significant relation with pre and post-operative bilirubin change. Conclusion: Transient but not permanent alterations of hepatic enzymes after coronary artery bypass grafting presumably attributed to the decreased hepatic flow, hypoxia, or pump-induced inflammation.

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“…Despite excellent improvements in modern CPB, the manifestations of side effects have been repeatedly reported [Kazuo 2005]. The study of the underlying mechanisms and development of protective strategies for the pathophysiological processes of CPB were more important than CPB technology itself in clinical investigation [Kawahira 2003]. Earlier experimental studies with the aim of achieving experimental CPB have been limited to large animals.…”

Section: E75mentioning

confidence: 99%