Postoperative jaundice after cardiac surgery

The frequency and pattern of hyperbilirubinemia after open-heart surgery and its severe perioperative complications are not well clarified. The purpose of this study was to investigate the incidence and nature of postoperative jaundice in patients undergoing cardiac operation, to analyze the determinants, and to identify the clinical significance of this complication with regard to the associated morbidity and mortality.

A prospective observational study was made during the period of 2003-2004 in a Surgical Intensive Care Unit of a Cardiac Surgery Center, Athens. One hundred twenty-eight adult patients for open heart surgery were divided into three groups. Group A included 50 patients who underwent coronary artery bypass crafting (CABG), group B 31 patients who were subjected to aortic valve replacement (AVR)+CABG and group C 47 patients who underwent mitral valve replacement (MVR)+CABG. Aminotransferases, alkaline phosphatase, gamma-glutamyl-transpeptidase and both types of bilirubin were determined at admission, 24 hours after the operation and thereafter according to clinical evolution. The presence of jaundice was associated with elevated serum bilirubin above 3 mg/dl.

Hyperbilirubinemia developed in 34 patients (26.5%). The incidence of postoperative jaundice was higher in patients who were subjected to MVR+CABG than to CABG and AVR+CABG. Hyperbilirubinemia was correlated with prolonged cardiopulmonary by-pass time (P<0.001), aortic cross-clamping time (P<0.001), the use of intra aortic balloon pumping (P<0.001), the administration of inotrops and the number of blood and plasma transfusions. Postoperative jaundice resulted mainly from an increase in conjugated bilirubin.

Although hyperbilirubinemia seems to be multifactorial, the type of operation, the preoperative hepatic dysfunction due to advanced heart failure (NYHA II-III) and the decreased hepatic flow during the operation seem to determine the incidence of jaundice.