Cardiac operations for patients with chronic liver disease.
BACKGROUND
Due to the systemic and hepatic effects of cardiopulmonary bypass (CPB), open-heart surgery for patients with chronic liver disease is associated with high mortality and morbidity. In this retrospective study, we present our results of cardiac surgery on patients with non-cardiac cirrhosis.


METHODS
Between March 1996 and April 2000, 10 patients with chronic liver disease had open-heart surgery in our institution. Six patients were male and four were female, with a mean age of 57.1 +/- 6.85 years. Preoperative severity of liver disease was determined according to Child classification. Four cases (40%) were Child class A and six (60%) were class B. Coronary artery bypass grafting was performed in four cases, and the remaining six operations were for aortic valve replacement (AVR) and/or mitral valve replacement (MVR). Eight of the operations (80%) were performed by using cardiopulmonary bypass and two (20%) were performed as beating heart surgery.


RESULTS
Chest tube drainage and transfusion needs of these patients were three times the average normal values. Three of the patients for whom CPB was used, all of them in Child class B, died. None of the patients in Child class A died. This resulted in an overall mortality rate of 30%, with mortality of 50% for the Child B group. There was no mortality for any patient who underwent cardiac surgery on the beating heart or cardiac surgery of short duration on CPB. Common characteristics of cases that were associated with high morbidity and mortality included increased postoperative hemorrhagic chest tube output, dependency on mechanical ventilation, hepatic and renal failure, gastrointestinal bleeding, and sepsis. None of the patients died of cardiac failure.


CONCLUSIONS
Our findings indicate that cardiac operations may be performed with good results for patients suffering from liver disease of mild severity (Child A), but cardiac interventions that include CPB in conjunction with advanced hepatic pathologies are associated with high mortality and morbidity. Cardiac surgery (whether valvular or coronary artery surgery) for patients with chronic liver disease should be carried out with a short duration of CPB or should be done on the beating heart, if possible, in the case of coronary artery surgery.
Kaplan
Mehmet
M
Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey. mehmetkaplan@superonline.com
Cimen
Serdar
S
Kut
Mustafa Sinan
MS
Demirtas
Mahmut Murat
MM
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome