The impact of cirrhosis in patients undergoing cardiac surgery: a retrospective observational cohort study

Abstract

Purpose Patients with cirrhosis and concomitant coronary/valvular heart disease present a clinical dilemma. The therapeutic outcome of major cardiac surgery is significantly poorer in patients with cirrhosis compared with patients without cirrhosis. To address this, we aimed to identify associations between the severity of cirrhosis and post-cardiac surgical outcomes. Methods A historical cohort analysis of patients undergoing cardiac surgery at the University of Alberta Hospital from January 2004 to December 2014 was used to identify and propensity score-match 60 patients with cirrhosis to 310 patients without cirrhosis. The relationships between cirrhosis and i) mortality, ii) postoperative complications, and iii) requirement of healthcare resources were evaluated. Results Ten-year mortality was significantly higher in cirrhotic patients compared with propensity score-matched non-cirrhotic patients (40% vs 20%; relative risk [RR], 2.0; 95% confidence interval [CI], 1.3 to 2.9; P = 0.001). Cirrhotic patients had more complications (63% vs 48%; RR, 1.3; 95% CI, 1.05 to 1.7; P = 0.02), longer median [interquartile range (IQR)] intensive care unit stays (5 [3-11] vs 2 [1-4] days; P \ 0.001), time on mechanical ventilation (median [IQR] 2 [1-5] vs 1 [0.5-1.2] days; P\ 0.001) and more frequently required renal replacement therapy (15% vs 6%;

The Effect of Liver Cirrhosis on Patients Undergoing Cardiac Surgery

“…Then, there were 13 studies left for qualitative synthesis. Finally, seven eligible studies were included in this analysis [ 13 14 15 16 17 18 19 ] ( Figure 1 ).…”

“…The aim of this pooling-up analysis was to figure out if there was an impact of LC on cardiac surgery. A total of seven studies containing 1,535,129 patients who underwent cardiac surgery were included [ 13 14 15 16 17 18 19 ]. All seven studies reported LC and non-LC groups.…”

“…Controversy remained over the relationship between LC and cardiac surgery. Among the included studies, some reported that patients with LC had a poor prognosis after cardiac surgery [ 13 14 15 16 17 ]. One of these studies divided the LC patients into two groups, which were bound by the CP score [ 19 ].…”

“…However, according to our review of previous studies, the effects of LC on the postoperative outcomes of cardiac surgery continued to be controversial. Some studies suggest a poor effect of LC on postoperative outcomes in cardiac surgery [ 13 14 15 16 17 ]. Other studies demonstrated that there was no association between LC and postoperative cardiac surgery outcomes [ 18 19 ].…”

Cirrhotic Patients Undergoing Cardiac Surgery: Why Not to Develop a More Specific Heart-Liver Score?

“…Eventually, despite especially MELD score gives indisputably useful precepts to quantify the severity of chronic hepatopathy, it seems necessary to develop a more specific new risk score dedicated to cirrhotic patients having to undergo cardiac surgery in the respect of the impact of liver disease on final clinical outcome [7].…”