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Preoperative evaluation of patients with liver cirrhosis undergoing open heart surgery

Takashi Murashita1, Tatsuhiko Komiya, Nobushige Tamura

  • 1Department of Cardiovascular Surgery, Kurashiki Central Hospital, Miwa, Kurashiki, Okayama, Japan. tm8937@kchnet.or.jp

General Thoracic and Cardiovascular Surgery
|June 18, 2009
PubMed

Insights

Open heart surgery in liver cirrhosis patients shows high mortality and morbidity, even in Child class A. The Child-Pugh classification may not adequately predict outcomes, suggesting other factors like serum cholinesterase and platelet count are crucial.

Area of Science:

  • Cardiology
  • Hepatology
  • Surgical Outcomes

Background:

  • Clinical outcomes after open heart surgery in liver cirrhosis patients are often unsatisfactory.
  • The Child-Pugh classification is a standard method for assessing hepatic function.
  • Previous reports suggest open heart surgery may be safe in mild liver cirrhosis.

Purpose of the Study:

  • To examine clinical outcomes of open heart surgery in liver cirrhosis patients.
  • To evaluate the usefulness of the Child-Pugh classification in predicting surgical outcomes.
  • To identify risk factors for adverse events in this patient population.

Main Methods:

  • Retrospective review of 12 liver cirrhosis patients undergoing open heart surgery (2002-2006).
  • Patients were classified using the Child-Pugh system (Class A and B).
  • Clinical outcomes, including mortality and morbidity, were analyzed to determine risk factors.

Main Results:

  • Overall mortality was 50% for Child class A and 17% for Child class B.
  • Major postoperative morbidity occurred in 50% of Child class A and 100% of Child class B patients.
  • Lower serum cholinesterase and platelet levels were associated with major morbidities.

Conclusions:

  • High mortality and morbidity rates were observed, even in Child class A patients.
  • The Child-Pugh classification appears insufficient for evaluating hepatic function in this context.
  • Serum cholinesterase levels and platelet counts may be more valuable predictors of surgical risk.
Abstract

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