Early and late outcome of cardiac surgery in patients with liver cirrhosis

✍ Scribed by Farzan Filsoufi; Sacha P. Salzberg; Parwis B. Rahmanian; Thomas D. Schiano; Hussien Elsiesy; Anthony Squire; David H. Adams

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 148 KB
• Volume: 13
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21075

✦ Synopsis

Liver cirrhosis is a major risk factor in general surgery. Few studies have reported on the outcome of cardiac surgery in these patients. Herein we report our recent experience in this high-risk patient population according to the Child-Turcotte-Pugh classification and Model for End-Stage Liver Disease (MELD) score. Between January 1998 and December 2004, 27 patients (mean age 58 Ϯ 10 yr, 20 male) with cirrhosis who underwent cardiac surgery were identified. Patients were in Child-Turcotte-Pugh class A (n ϭ 10), B (n ϭ 11), and C (n ϭ 6) and mean MELD score was 14.2 Ϯ 4.2. Operative mortality was 26% (n ϭ 7). Stratified mortality according to Child-Turcotte-Pugh class was 11%, 18%, and 67% for class A, B, and C, respectively. No mortality occurred in patients who had revascularization without the use of cardiopulmonary bypass (n ϭ 5). The 1-yr survival was 80%, 45%, and 16% for Child-Turcotte-Pugh class A, B, and C, respectively (P ϭ 0.02). Major postoperative complications occurred in 22%, 56%, and 100% for Child-Turcotte-Pugh class A, B, and C, respectively. Child-Turcotte-Pugh classification was a better predictor of hospital mortality (P ϭ 0.02) compared to MELD score (P ϭ 0.065). In conclusion, our results suggest that cardiac surgery can be performed safely in patients with Child-Turcotte-Pugh class A and selected patients with class B. Operative mortality remains high in class C patients. Careful patient selection is critical in order to improve surgical outcome in patients with cirrhosis.