Original article: cardiovascular
Clinical outcome after cardiac operations in patients with cirrhosis

https://doi.org/10.1016/j.athoracsur.2003.06.021Get rights and content

Abstract

Background

To evaluate the clinical outcome after cardiac operations in patients with cirrhosis, a retrospective study was undertaken.

Methods

Between 1989 and 2003, 18 patients with cirrhosis who underwent cardiac operations were identified. Their preoperative status and postoperative clinical results were assessed.

Results

Ten patients were classified as having Child-Pugh class A cirrhosis, 7 as having class B cirrhosis, and 1 as having class C cirrhosis. Fifteen of 18 patients underwent cardiac surgery using cardiopulmonary bypass, and the remaining 3 patients with class B cirrhosis received coronary artery bypass grafting without cardiopulmonary bypass. In patients undergoing cardiopulmonary bypass, 60% of those with class A cirrhosis and 100% of those with class B cirrhosis and class C cirrhosis had postoperative major complications, including infection, respiratory failure, renal failure, bleeding, and gastrointestinal disorder. One of 3 patients (33%) with class B cirrhosis undergoing coronary artery bypass grafting without cardiopulmonary bypass had major complications. The overall postoperative mortality rate was 17%. Hospital mortality of patients with class A cirrhosis, class B cirrhosis, and class C cirrhosis undergoing cardiopulmonary bypass was 0%, 50%, and 100%, respectively. None of 3 patients with class B cirrhosis undergoing coronary artery bypass grafting without cardiopulmonary bypass died in this study.

Conclusions

Although the incidence of major complications was high, patients with Child-Pugh class A cirrhosis tolerated cardiac surgery satisfactorily. Patients with more advanced cirrhosis, however, may not be suitable for elective cardiac operations with cardiopulmonary bypass. Although our results are not conclusive, coronary artery bypass grafting without cardiopulmonary bypass can be an alternative therapeutic strategy for patients with advanced cirrhosis requiring surgical revascularization.

Section snippets

Patients and methods

We reviewed the records of all patients who underwent cardiovascular surgery at Kurume University from February 1989 to January 2003. Eighteen patients were found to have a preoperative history of cirrhosis confirmed by the medical records. The diagnosis of cirrhosis was made either by liver biopsy or signs of portal hypertension with characteristic morphologic changes of the liver and spleen confirmed by ultrasound, computed tomography, and magnetic resonance imaging. Other diagnostic

Patient characteristics

Preoperative patient characteristics and liver function tests for 18 patients were summarized in Table 1, Table 2. The causes of cirrhosis were viral hepatitis in 12 patients, alcohol related in 3, congestive heart failure in 1, primary biliary cirrhosis in 1, and unknown in 1. Four patients had mild to moderate ascites, and 8 had esophageal or gastric varices preoperatively. Ten patients were classified as having Child-Pugh class A cirrhosis, 7 as having Child-Pugh class B cirrhosis, and 1 as

Comment

Several epidemiologic studies have demonstrated that cirrhosis and hepatocellular carcinoma caused by hepatitis B and C virus infection were highly prevalent in the Asian countries, especially in Japan 7, 8. Although the prevalence declined gradually, at least 4% of elderly Japanese have contracted viral hepatitis [9]. Moreover, because of a steep increase in alcohol consumption, mortality as a result of alcohol-related liver disease is increasing [10]. Therefore, liver disease is still a major

Acknowledgements

This work was supported in part by the Grant-in-Aid for Encouragement of Young Scientists, Japan Society for the Promotion of Science (grant A-13770754 and grant A-14770696) and Grant-in-Aid for scientific research (grant C-13671416 and grant C-14571290), Japan.

References (19)

There are more references available in the full text version of this article.

Cited by (155)

  • Anesthesia in patients with chronic liver disease: An updated review

    2023, Clinics and Research in Hepatology and Gastroenterology
  • Blood Transfusions in Elective Cardiac Surgery: The Debate Continues

    2023, Journal of Cardiothoracic and Vascular Anesthesia
  • Cardiovascular assessment before liver transplantation

    2022, Cardio-Hepatology: Connections Between Hepatic and Cardiovascular Disease
  • Avatrombopag Use in Patient With Thromboembolic Risks Listed for Combined Coronary Artery Bypass Grafting and Liver Transplant: A Case Report

    2021, Transplantation Proceedings
    Citation Excerpt :

    He had no thrombotic or bleeding complications after his combined CABG and LT. For the treatment of his PVT, he was initiated on therapeutic anticoagulation with a vitamin K antagonist on postoperative day 20, once his PLT count stabilized, which was continued for 3 months. Different strategies of CABG in liver patients, including off-pump (no cardiac bypass) CABG, have been described to minimize some of the thrombocytopenia-associated complications [4]. To our knowledge, this is the first case report describing the role of avatrombopag in patients with CAD and liver disease who required a simultaneous CABG and LT. This is of particular importance in this patient because of his unique thromboembolic risks for cardiac vascular graft thrombosis and hepatic artery thrombosis, which can be life-threatening.

View all citing articles on Scopus
View full text