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Does gallstone formation after open cardiac surgery result only from latent hemolysis by replaced valves?
1Division of Internal Medicine, Tsurumai Hospital, Chiba University, School of Medicine, Japan.
Insights
Open heart surgery using a heart-lung machine is linked to increased gallstone formation due to hemolysis. This study tracked patients post-surgery, finding a significant rise in gallstones within a year.
Area of Science:
- Cardiovascular Surgery
- Gastroenterology
- Hematology
Background:
- Gallstone formation is a common concern.
- The impact of open heart surgery on gallstone development requires further investigation.
Purpose of the Study:
- To investigate the association between open heart surgery and the incidence of gallstone formation.
- To explore the role of hemolysis in post-cardiac surgery gallstone development.
Main Methods:
- Prospective study comparing 51 patients undergoing cardiac surgery with a heart-lung machine (Group A) to 52 healthy controls (Group B).
- Patients were monitored for gallstones via ultrasonography for 24 months post-surgery.
- Hemolysis markers were assessed pre-operatively and at multiple time points after surgery.
Main Results:
- Gallstone incidence was significantly higher in Group A (30.4% by 12 months) compared to Group B (p < 0.01).
- CT scans indicated pigment stones in most assessed patients.
- Abnormal hemolysis markers (hemoglobin, haptoglobin, lactate dehydrogenase) were observed immediately after surgery in all cardiac surgery patients.
Conclusions:
- The use of a heart-lung machine during open cardiac surgery, leading to hemolysis, is closely related to subsequent gallstone formation.
- Hemolysis appears to be a key factor in the increased risk of gallstones after this procedure.
Objectives:
To clarify the relationship between open heart surgery and gallstone formation.
Methods:
Fifty-one patients without gallstones (Group A) underwent cardiac surgery using a heart-lung machine and were followed for 24 months by ultrasonography. Blood tests of hemolysis markers were examined before, immediately after, and 3, 6, and 12 months after surgery. And 52 healthy candidates without gallstone (Group B) also were followed for 24 months.
Results:
The cumulative gallstone incidence in Group A was 15.7% at 3 months after surgery, 23.9% at 6 months, and 30.4% at and beyond 12 months and was significantly higher than that of Group B (p < 0.01). The stones showed a high dense pattern, indicative of pigment stones, in eight of the 10 patients assessed by CT. With respect to the type of surgery, latent hemolysis was seen only in patients who underwent mechanical valve replacement. However, there were no significant differences in the gallstone incidence between the patients who underwent mechanical valve replacement and those who underwent another cardiac surgery. The values of hemoglobin, haptoglobin, and lactate dehydrogenase showed abnormal values immediately after surgery, regardless of mechanical valve replacement or another cardiac surgery.
Conclusions:
The use of a heart-lung machine, which produces hemolysis, appears to have a close relation to gallstone formation after open cardiac surgery.