title: Early and late outcomes of cardiac operations in patients with cirrhosis: a retrospective survival-rate analysis of 47 patients over 8 years.
abstract: OBJECTIVE
  Patients with liver cirrhosis are considered as high-risk population for cardiac surgery. The aim of this study was to review mortality and mid-term outcome of patients with liver cirrhosis requiring coronary artery bypass graft (CABG), valve replacement, or combined procedures.
  
  
  METHODS
  Between July 1997 and December 2006, 47 patients (mean age 65.4 ± 11.7 years) with liver cirrhosis were operated for CABG (21 patients), aortic valve replacement /mitral valve replacement (14 patients), CABG/VR (9 patients) or aortic dissection/tumorexstirpation (3 patients) (group I). Thirty-three patients were classified as Child-Pugh class A (subgroup A), 14 patients as Child-Pugh class B cirrhosis (subgroup B). Postoperative complications/mortality were analyzed retrospectively and compared with a propensity-score pair-matched control group of 47 patients (group II). Follow-up ranged from 0.1 to 11.5 years (mean 3.9 ± 0.25 years) and was complete for 100%.
  
  
  RESULTS
  Necessity of blood products was higher in group I (red cells, fresh frozen plama, platelets; P < 0.01). Chest-tube output (group I 1113 ± 857 vs. group II 849 ± 521; P = 0.15) and re-exploration rate (8.5 vs. 0%; P = 0.11) were slightly accelerated. Ventilation time and ICU-stay was prolonged (P < 0.015). Thirty-day mortality showed 19.1% (group I) versus 8.5% (group II) (P < 0.01), 6.1% (subgroup A) versus 50% (subgroup B) (P < 0.01). Operative risk in subgroup A was not significantly increased compared with control group (P = 0.68). In Child-B operative risk was 15.5-fold higher than in Child-A cirrhosis (P < 0.001). Postcardiotomy syndrome and pleurisy were more frequent in the cirrhosis group (4/47 vs. 0/47; P = 0.11). Actuarial survival after 3, 5 and 8 years was: group I 78.6, 75.6, and 70.2% versus group II 89.1, 85.7, and 85.7% (P = 0.08). Subgroup survival analysis was: group A 90.7, 86.6, and 78.5% versus group B 50, 50, and 50% (P < 0.01).
  
  
  CONCLUSIONS
  Cardiac surgery can be performed safely in patients with Child-Pugh class A and selected patients with Child-Pugh class B cirrhosis. Mid-term survival-rates within 8 years were not significantly different compared with a propensity-score pair-matched control group without cirrhosis.
authors.affiliation: Department of Gastroenterology, Bogenhausen Academic Teaching Hospital dInstitut für medizinische Statistik und Epidemiologie, Technical University of Munich, University of Munich, Munich, Germany. Gastroenterologie@kh-bogenhausen.de
authors.forename: Felix
authors.initials: F
authors.lastname: Gundling
authors.forename: Holger
authors.initials: H
authors.lastname: Seidl
authors.forename: Laura
authors.initials: L
authors.lastname: Gansera
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.forename: Ellen
authors.initials: E
authors.lastname: Hoffmann
authors.forename: Bernhard M
authors.initials: BM
authors.lastname: Kemkes
authors.forename: Bernd
authors.initials: B
authors.lastname: Eichinger
authors.forename: Brigitte
authors.initials: B
authors.lastname: Gansera
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schepp
authors.forename: Fabian
authors.initials: F
authors.lastname: Schmidtler
mesh_terms: D000368:Aged; D016913:Blood Component Transfusion / Q000401:mortality; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D003422:Critical Care; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007442:Intubation, Intratracheal / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D057216:Propensity Score; D012086:Reoperation; D012121:Respiration, Artificial / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome