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Cardiac surgery in patients with liver cirrhosis
Cheng-Hsin Lin1, Fang-Yue Lin, Shoei-Shen Wang
1Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, China.
Insights
Cardiac surgery in liver cirrhosis patients is uncommon. This study found that while complications are frequent, cardiac operations can be performed safely in patients with mild to advanced liver cirrhosis.
Area of Science:
- Cardiology
- Hepatology
- Surgical Outcomes
Background:
- Cardiac surgery in patients with liver cirrhosis is rarely reported.
- Limited data exists on the clinical outcomes of cardiac operations in this patient population.
Purpose of the Study:
- To evaluate the clinical outcomes of cardiac surgery in patients diagnosed with non-alcoholic liver cirrhosis.
Main Methods:
- Retrospective review of patient case notes from January 1993 to May 2004.
- Collected preoperative, intraoperative, and postoperative variables.
- Classified liver cirrhosis severity using the Child-Pugh classification system.
Main Results:
- 18 patients with liver cirrhosis underwent cardiac surgery; 13 had hepatitis virus infection, 5 were alcohol-related.
- 13 patients were Child A, 4 were Child B, and 1 was Child C.
- Overall in-hospital mortality was 6% (1/18); no deaths occurred in Child B and C patients. Major complication rates were 39% for Child A and 80% for Child B and C.
Conclusions:
- Cardiac surgery in patients with liver cirrhosis is associated with a high rate of postoperative complications.
- Despite complications, cardiac operations can be performed safely in patients with both mild (Child A) and advanced (Child B and C) liver cirrhosis.
Background:
Cardiac surgery was infrequently performed in patients with liver cirrhosis, and its clinical outcome has been reported only in small series. We sought to evaluate the clinical outcome of cardiac operation in patients with noncardiac liver cirrhosis.
Methods:
Data were collected by a retrospective case note review. The preoperative, intraoperative, and postoperative variables were recorded. The severity of liver cirrhosis was graded using the Child-Pugh classification.
Results:
Between January 1993 and May 2004, 18 patients with liver cirrhosis underwent cardiac surgery at the authors' hospital. Thirteen patients had hepatitis virus infection, and 5 cases were alcohol related. Thirteen patients were classified as Child A cirrhosis, 4 were class B, and 1 was class C. Sixteen patients underwent cardiac surgery with the use of cardiopulmonary bypass, and 2 patients underwent off-pump coronary artery bypass surgery. The overall in-hospital mortality rate was 6% (1 of 18), and there was no death in 5 class B and C cirrhotic patients. The rate of major complication was 39% in class A and 80% in class B and C.
Conclusions:
Although the postoperative complication was common, cardiac operation could be performed safely in patients with mild and advanced liver cirrhosis.
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