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Investigation of Risk Factors Related to the Development of Hepatic Dysfunction in Patients with a Low and Moderate
Ayse Baysal1, Gonul Sagiroglu2, Mevlut Dogukan3
1Pendik Bolge Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
Insights
Low ejection fraction and extended aortic cross-clamp time are key risk factors for hepatic dysfunction after open-heart surgery. Valve surgeries present a higher risk of hyperbilirubinemia compared to coronary artery bypass grafting.
Area of Science:
- Cardiology
- Hepatology
- Surgical Research
Background:
- Hepatic dysfunction is a potential complication following open-heart surgery.
- Identifying risk factors is crucial for patient management and improving outcomes.
Purpose of the Study:
- To identify risk factors associated with hepatic dysfunction, specifically hyperbilirubinemia, in patients undergoing open-heart surgery.
- To compare the incidence of hyperbilirubinemia between coronary artery bypass graft (CABG) and valve surgery procedures.
Main Methods:
- Prospective investigation of 307 low-to-moderate cardiac risk patients undergoing CABG or valve surgery.
- Monitoring of liver function tests (ALT, AST, ALP, TBil, GGT, albumin) preoperatively and postoperatively.
- Logistic regression analysis to determine independent risk factors for postoperative hyperbilirubinemia.
Main Results:
- Postoperative hyperbilirubinemia occurred in 4% of CABG patients and 8.4% of valve surgery patients.
- Independent risk factors identified: low ejection fraction (EF), prolonged aortic cross-clamp (ACC) time, extended ICU stay, and longer extubation time.
- Valve surgeries were associated with a significantly higher incidence of hyperbilirubinemia compared to CABG.
Conclusions:
- Low ejection fraction and prolonged aortic cross-clamp time are significant independent risk factors for early postoperative hyperbilirubinemia in open-heart surgery with cardiopulmonary bypass.
- Valve replacement surgeries demonstrate a higher frequency of postoperative hyperbilirubinemia than CABG procedures.
Objective:
To determine the possible risk factors associated with hepatic dysfunction during open-heart surgeries.
Methods:
After excluding 71 patients, 307 patients with possible low and moderate cardiac risk who underwent either coronary artery bypass graft surgery (CABG) (n=176) or valve repair surgery (mitral valve, mitral and aortic valves and/or tricuspid valve) (n=131) were investigated prospectively during a 6-month period. Hyperbilirubinemia is defined as an occurrence of a plasma total bilirubin concentration >34 µmol/L (2 mg/dL) in any measurement during the postoperative period; the patients were divided into groups with or without postoperative hyperbilirubinemia. The collected parameters were: alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), total bilirubin (TBil), gamma-glutamyl transpeptidase (GGT) and albumin. The parameters were collected preoperatively and postoperatively on days 1, 3 and 7. Preoperative, intraoperative, and postoperative risk factors were investigated. Logistic regression analysis was performed to identify the risk factors for postoperative hyperbilirubinemia.
Results:
Postoperative hyperbilirubinemia was observed in 7 of 176 patients (4%) who underwent CABG, and in 11 of 131 patients (8.4%) who underwent valve replacement surgeries. Independent risk factors for early postoperative hyperbilirubinemia were found as: ejection fraction (EF), aortic cross-clamp (ACC) time, intensive care unit stay and extubation time (P<0.001). In comparison to CABG procedures, postoperative hyperbilirubinemia was observed more frequently in patients undergoing valve surgeries (P=0.027).
Conclusion:
Low EF and prolonged ACC time are significant independent risk factors for early postoperative hyperbilirubinemia during open-heart surgeries with cardiopulmonary bypass. Valve surgeries show a higher incidence of hyperbilirubinemia in comparison to CABG.
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