Predictive risk factors for patients with cirrhosis undergoing heart surgery

Area of Science:

• Cardiology
• Hepatology
• Surgical Risk Assessment

Background:

• Cirrhosis of the liver is associated with increased mortality and complications post-cardiac surgery.
• Current risk scores (EuroSCORE, STS score) do not adequately account for cirrhosis.
• This study investigates cirrhosis severity as a predictor of outcomes in cardiac surgery patients.

Purpose of the Study:

• To evaluate the impact of cirrhosis severity on mortality and complications in patients undergoing cardiac surgery with extracorporeal circulation.
• To identify preoperative factors, including cirrhosis severity, that predict outcomes in this patient population.

Main Methods:

• A single-center retrospective study of 109 consecutive patients with cirrhosis undergoing cardiac surgery with cardiopulmonary bypass between 2001 and 2011.
• Primary endpoints were 30-day and long-term mortality.
• Analysis included Child-Turcotte-Pugh (CHILD) classification, EuroSCORE, Model for End-Stage Liver Disease (MELD) score, and other preoperative factors.

Main Results:

• Thirty-day mortality was 26%, and 5-year survival was 19%.
• Patients with Child-Turcotte-Pugh C and B cirrhosis had significantly worse 30-day and 5-year survival compared to Child-Turcotte-Pugh A.
• Multivariate analysis identified MELD score and total protein as predictors of 30-day mortality, while EuroSCORE and MELD score predicted overall mortality.

Conclusions:

• Patients with cirrhosis undergoing cardiac surgery with extracorporeal circulation have a poor prognosis.
• Cirrhosis severity, as indicated by CHILD and MELD scores, significantly impacts patient outcomes.
• EuroSCORE and MELD score are valuable tools for assessing operative risk and guiding treatment decisions in cirrhotic patients undergoing cardiac surgery.