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Results of cardiac surgery in advanced liver cirrhosis

Naoto Morimoto1, Kenji Okada, Yutaka Okita

  • 1Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, chuo-ku, Kobe, Hyogo, 650-0017, Japan. naotofrcs@gmail.com

General Thoracic and Cardiovascular Surgery
|November 2, 2012
PubMed

Insights

Cardiac surgery in advanced liver cirrhosis patients is challenging but feasible. Selected patients can undergo cardiac surgery with acceptable outcomes, though redo surgeries carry higher mortality risks.

Area of Science:

  • Cardiology
  • Hepatology
  • Transplant Surgery

Background:

  • Cardiac surgery in patients with advanced liver cirrhosis presents significant challenges due to high reported mortality rates.
  • Liver cirrhosis severity impacts surgical risk, necessitating careful patient selection and management strategies.

Purpose of the Study:

  • To evaluate the clinical outcomes of cardiac surgery performed on patients diagnosed with advanced liver cirrhosis.
  • To identify factors influencing mortality and complications in this high-risk patient population.

Main Methods:

  • Retrospective review of 18 patients with advanced liver cirrhosis (Child-Pugh class B or C) who underwent cardiac surgery between 1999 and 2009.
  • Assessment of liver cirrhosis severity using Child-Pugh class, Child-Pugh score, and MELD score.
  • Specific intraoperative management included higher cardiopulmonary bypass flow rates, maintained hematocrit, aggressive treatment of tricuspid regurgitation, and dilutional ultrafiltration.

Main Results:

  • The overall in-hospital mortality rate was 17% (3 of 18), with causes including liver failure, variceal bleeding, and bacteremia.
  • Postoperative liver failure occurred in 11% of patients.
  • While Child-Pugh scores did not correlate with mortality, the MELD score was significantly higher in patients who died (p=0.001).
  • Redo surgery demonstrated a high mortality rate of 50%.

Conclusions:

  • Cardiac surgery can be safely performed in selected patients with advanced liver cirrhosis.
  • Careful patient selection is crucial, particularly for redo procedures where mortality is substantially higher.
  • MELD score may serve as a valuable predictor of hospital mortality in this cohort.
Abstract

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