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Prediction of postoperative hepatic dysfunction after cardiac surgery in patients with chronic congestive heart

Hiroyuki Nishi1, Toshiki Takahashi, Hajime Ichikawa

  • 1Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. nishi24@jc4.so-net.ne.jp

General Thoracic and Cardiovascular Surgery
|July 15, 2009
PubMed

Insights

Preoperative liver function tests, including total bilirubin (T-bil) and albumin (Alb), can predict postoperative liver dysfunction in severe valvular disease patients. Cholinesterase (ChE) also predicts mortality, leading to a new prognostic liver score.

Area of Science:

  • Cardiology
  • Hepatology
  • Surgical Oncology

Background:

  • Chronic congestive liver dysfunction is a significant comorbidity in patients undergoing open-heart surgery for advanced valvular disease.
  • Accurate preoperative assessment of liver function is crucial for predicting outcomes in these high-risk patients.

Purpose of the Study:

  • To explore the prognostic value of preoperative liver function tests in patients with severe valvular disease and associated congestive liver dysfunction.
  • To identify key indicators for predicting postoperative liver dysfunction and mortality.

Main Methods:

  • A cohort of 63 patients with valvular disease and moderate to severe tricuspid regurgitation were studied between 1997 and 2004.
  • Preoperative assessments included indocyanine green retention rate at 15 min (ICG15), Child-Pugh score, serum total bilirubin (T-bil), aspartate aminotransferase (AST), alanine aminotransferase (ALT), cholinesterase (ChE), albumin (Alb), and prothrombin time.
  • These factors were compared with postoperative liver dysfunction and mortality, and a new liver function score was developed.

Main Results:

  • Eight in-hospital deaths (13%) and 17 cases of postoperative liver dysfunction were observed.
  • Univariate analysis showed significant differences in preoperative T-bil, Alb, ChE, ICG15, and Child-Pugh score between patients with and without liver dysfunction.
  • Multivariate analysis identified preoperative T-bil as a significant predictor of postoperative liver dysfunction and preoperative ChE as a predictor of mortality.

Conclusions:

  • Preoperative serum total bilirubin (T-bil) and albumin (Alb) levels are valuable for prognosticating postoperative liver dysfunction in severe valvular disease.
  • Preoperative cholinesterase (ChE) is a significant predictor of mortality.
  • A novel liver function score incorporating T-bil, ChE, and Alb is proposed for predicting postoperative hepatic dysfunction and patient outcomes.
Abstract

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