Open-heart surgery in patients with liver cirrhosis

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.

Between May 1996 and June 2005, 24 patients with LC underwent an open-heart surgery in our institution.

There were 14 females and 10 males. Their age ranged from 36 to 72 (average 53+/-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+/-53 and 90+/-42 min, respectively. In the first 24h after operation, the mean chest tube output was 1080+/-320 ml. Mean duration of mechanical ventilation was 32+/-22 h and mean intensive care unit stay time was 11+/-8 days. Sixty-six 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.

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.