Cardiac surgery in cirrhotic patients: results and evaluation of risk factors

• Published in: European journal of cardio-thoracic surgery Vol. 42; no. 2; pp. 293 - 299
• Main Authors: Vanhuyse, Fabrice, Maureira, Pablo, Portocarrero, Eric, Laurent, Nicolas, Lekehal, Malik, Carteaux, Jean-Pierre, Villemot, Jean-Pierre
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.08.2012
• Subjects: Aged; Biological and medical sciences; Blood Loss, Surgical - statistics & numerical data; Blood Transfusion - statistics & numerical data; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Epidemiologic Methods; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - mortality; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Other diseases. Semiology; Pneumology; Postoperative Complications - mortality; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; EuroSCORE; Hypoalbuminaemia; MELD score; Liver cirrhosis; Child-Pugh classification; Human; Evaluation; Liver; Albumin; Hepatic disease; Cardiovascular disease; Cardiac surgery; Result; Hypoalbuminemia; Child―Pugh classification; Cirrhosis; Metabolic disorder; Classification; Risk factor; Digestive diseases; Models; Circulatory system; Cardiology; Child; Pneumology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezr320

OBJECTIVES Liver cirrhosis increases mortality and morbidity following cardiac surgery. This study evaluated the results of cardiac surgery in cirrhotic patients and the relevance of EuroSCORE, Child-Turcotte-Pugh (CTP) class and model for end-stage liver disease (MELD) score in terms of prediction of surgical mortality and survival. METHODS The study involved 34 patients with hepatic cirrhosis who underwent cardiac surgery between January 1996 and January 2010. RESULTS The in-hospital mortality was 26%. Postoperative mortality of patients with CTP class A, B or C was 18, 40 and 100%, respectively. In univariate analysis, a history of cerebrovascular disease and hypoalbuminaemia was predictive of operative mortality. Multivariate exact logistic regression revealed that hypoalbuminaemia was an independent factor. Long-term survival was 63 ± 0.08% at 1 year and 40.2 ± 0.12% at 5 years. The 1-year survival for CTP A, B and C was 76.7 ± 0.09, 60 ± 15.4 and 0%, respectively, and the 5-year survival was 60 ± 15.4, 25 ± 0.19 and 0%, respectively. The EuroSCORE was not a discriminant [area under the curve (AUC): 0.57 ± 0.15]. The performance of CTP class and MELD score was better, but neither provided optimal discrimination: AUC was 0.691 ± 0.110 for MELD and 0.658 ± 0.10 for CTP class. CONCLUSIONS Cardiac surgery can be performed safely in CTP class A patients. In CTP C patients, surgery is hazardous, and an alternative treatment must be considered. In CTP B, the MELD score could be helpful in deciding whether surgical intervention is a reasonable option.