Indication and perioperative management for cardiac surgery in patients with liver cirrhosis. Our experience with 3 patients.
Three patients with noncardiac Child A cirrhosis underwent cardiac surgery. All survived surgery, but 2 died during follow-up periods. A 61-year-old woman who underwent successful double valve replacement died of diabetic coma and severe acidosis due to intestinal necrosis 18 months later. A 57-year-old woman who underwent successful mitral valve replacement died of liver failure induced by heart failure 9 years later. A 45-year-old man who underwent coronary artery bypass grafting is doing well 18 months after discharge. Proper perioperative management, including high-flow cardiopulmonary bypass, pharmacological and mechanical circulatory support, and mechanical respiratory support prevented further, potentially lethal, hepatic dysfunction, leading to good early surgical results. We concluded that patients with Child A cirrhosis could tolerate cardiac surgery. Subsequent surgical results, however, were unsatisfactory, and more careful follow-up is necessary to obtain better late results.
Ninomiya
M
M
Department of Cardiothoracic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Takamoto
S
S
Kotsuka
Y
Y
Ohtsuka
T
T
D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D012307:Risk Factors