Safety of cardiac surgery for patients with cirrhosis and Child-Pugh scores less than 8.
OBJECTIVE
Advanced liver disease is a significant risk factor for perioperative complications after cardiac surgery. However, no published studies have adjusted the observed outcomes for other well-known, non-liver-related factors that affect mortality. We evaluated the effects of cirrhosis on operative mortality and morbidity after cardiac surgery, after adjusting for nonrelated risk factors associated with liver disease.


METHODS
We analyzed data from patients with cirrhosis who underwent cardiac surgery with cardiopulmonary bypass from 1992 to 2009 (n = 54). Patients who underwent cardiac surgery at the same institution were identified during the same time period and matched 1:4 by using propensity score matching (controls, n = 216). Child-Pugh (CP) class and score were calculated for the patients with cirrhosis. Mortality and morbidity were determined after 30 and 90 days.


RESULTS
Within 90 days, 4.6% of patients with CP score <8 and 70% of patients with CP score ≥ 8 died (P < .017). Mortality of patients with CP score <8 was comparable to that of matched controls. Patients with CP scores <8 had significantly shorter average length of hospital stay (15.6 vs 26 days; P < .017) and were less likely to develop renal failure (P < .017) and require dialysis (P < .017) than patients with CP scores ≥ 8; these values were similar between patients with CP scores <8 and their matched controls.


CONCLUSIONS
After adjusting for non-liver-related risk factors, patients with compensated cirrhosis (defined by CP score <8) can undergo cardiac surgery with cardiopulmonary bypass with no significant increases in postoperative mortality and morbidity. For this group of patients, comorbidities, rather than liver failure, appear to account for the occasional death.
Department of Internal Medicine, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
Carole
C
Macaron
Ibrahim A
IA
Hanouneh
Amitabh
A
Suman
Rocio
R
Lopez
Douglas
D
Johnston
William W
WW
Carey
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003956:Dialysis; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome