Open-heart surgery in patients with liver cirrhosis

Abstract

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. #

Preoperative evaluation of patients with liver cirrhosis undergoing open heart surgery

“…An and colleagues reported that 25% of patients required re-exploration for mediastinal bleeding. 4 In our study, 33% of patients needed re-exploration for bleeding. The rate was much higher than in noncirrhosis patients and much more packed red blood cells, fresh frozen plasma, and platelets were needed.…”

“…3 An and colleagues reported that the postoperative mortality of patients with Child class A, B, and C were 6%, 67%, and 100%, respectively. 4 Lin and colleagues reported that the overall mortality of liver cirrhosis patients was only 6%, and there were no deaths among Child B and C patients. They concluded that patients with mild and even advanced liver cirrhosis can tolerate open heart surgery.…”

“…10 In addition, hypothermia, hemodilution, and hypoperfusion during CPB may be responsible for the morbidity and mortality. 11 Therefore, Hayashida et al 4 recommended off-pump coronary artery bypass (OPCAB) because the use of CPB can be avoided. They reported that none of the three patients with class B cirrhosis undergoing OPCAB died.…”

“…Some studies reported that the in-hospital mortality rate is low for patients with Child-Pugh class A cirrhosis, whereas that of patients with Child-Pugh class B or C cirrhosis is relatively high. [1][2][3][4] The Child-Pugh classifi cation is a widely used method for evaluating hepatic function. However, it is diffi cult to evaluate hepatic function with one or two tests because the liver has many functions.…”

Equal 3-Year Outcomes for Kidney Transplantation Alone in HCV-Positive Patients With Cirrhosis

“…[11][12][13][14][15] The life expectancy of patients with cirrhosis is 40% of that of the general population. 16 The standardized mortality ratio for patients with cirrhosis for all causes of death combined is increased by 12-fold, with a relative 1-year survival rate of 67%.…”