Frequency, risk factors and prognosis of postoperative hyperbilirubinemia after heart valve surgery

Despite recent advances in cardiovascular surgery, hyperbilirubinemia after heart valve surgery occurs often and the mechanism is not well clarified. We evaluated the incidence and nature of postoperative hyperbilirubinemia in heart valve surgery patients to analyze its risk factors and to identify its clinical significance for associated morbidity and mortality.

We investigated 334 consecutive patients who underwent heart valve surgery. Postoperative hyperbilirubinemia was defined as total serum bilirubin concentration greater than 3 mg/dl at any postoperative measurement point.

Postoperative hyperbilirubinemia developed in 63 patients (19.0%) and was associated with greater in-hospital mortality (15.9 vs. 1.5%, p < 0.01). Univariate analysis revealed congestive heart failure history, cardiogenic shock, infective endocarditis, preoperative liver dysfunction, longer cardiopulmonary bypass time and transfusion as significantly related to postoperative hyperbilirubinemia. In multivariate analysis, preoperative liver dysfunction [odds ratio (OR) 6.5, p < 0.05] and longer cardiopulmonary bypass time (OR 1.007, p < 0.01) were independent predictors. In postoperative hyperbilirubinemia patients, preoperative New York Heart Association status and history of heart failure were associated with outcome.

Postoperative hyperbilirubinemia remains common in patients undergoing heart valve surgery and is associated with a high rate of in-hospital mortality. For patients with heart failure or liver dysfunction, meticulous operative management is required to reduce cardiopulmonary bypass time and transfusion.