Early jaundice after open-heart surgery

Abstract

Two hundred and thirty-two patients subjected to open-heart surgery have been analysed regarding early post-operative jaundice. The overall incidence of jaundice was 13%, being 55% where the mitral valve and 5% where the aortic valve was predominantly involved. Only one out of 59 patients in whom a congenital lesion was repaired became jaundiced. Hyperbilirubinaemia without jaundice was common. The biochemical pattern of the jaundice was singularly constant, the most striking feature being the rise in serum bilirubin level. The highest value occurred between the second and tenth post-operative days. At total levels less than about 4 mg. /100 ml. the unconjugated fraction usually equalled or exceeded the conjugated. The alkaline phosphatase was normal in the first post-operative week but was sometimes slightly raised in the second, when the bilirubin levels were usually falling. The S.G.P.T. was normal or very slightly raised. Bilirubinuria was present. Centrilobular congestion with no evidence of extrahepatic biliary obstruction was found at post-mortem examination, and liver biopsy in three very severely jaundiced patients revealed only intrahepatic cholestasis. Pre-operative evidence of liver dysfunction was found in 13 patients who subsequently became jaundiced. Twelve had lesions predominantly affecting the mitral valve. Haemolysis, heart failure, and infection probably all played a part, and the effect of operation per se on liver function has been discussed. Drugs and viral hepatitis do not seem implicated in our patients. Maintenance of lower venous pressures in the post-operative period and the use of less blood reduced both the incidence and severity of jaundice.

Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

“…The decreased hepatic capacities for bilirubin disposal and bile transport, in addition to the haemolysis from CPB, cardiotomy suction, and mechanical prosthesis result in the postoperative hyperbilirubinemia. Both Weber [1] and Lockey [2] proposed that haemolysis contributed to postoperative jaundice; in contrast, Collins [3] and Chu [4] reported that serum TB concentration mainly resulted from increased CB, i.e., hepatic cellular jaundice. However, for the patients with postoperative hyperbilirubinemia in our study, 80.2% of the increased TB was due to an increase of both CB and UCB; 56.2% reached peak TB concentration on the first postoperative day, 33.5% on the second day and 10.3% on the seventh day.…”

“…Despite advances in techniques of perioperative management in cardiac operations, CPB, and cardiac anaesthesia, early hyperbilirubinemia after modern extracorporeal circulation surgery still occurs frequently. With regard to the effects of the disease and operation category, controversies exist about whether incidence differs among different disease category [2,3] . The current results showed that postoperative hyperbilirubinemia occurred more frequently in patients receiving valvular replacements than in patients undergoing CABG or operation for CHD (P < 0.01).…”

“…It has been well known that early jaundice and transient liver damage could occur after extracorporeal circulation surgery [1,2] . The mortality can reach 85%-90% once the postoperative jaundice progresses to hepatic failure [4][5][6][7] .…”

“…According to earlier studies, overall incidence of postoperative hyperbilirubinemia ranges from about 8.6% to even as high as 40% [1][2][3] . Despite improvements in perioperative management, as well as in surgical and anaesthetic techniques, early hyperbilirubinemia after modern extracorporeal circulation surgery is still seen quite often.…”

Jaundice after open heart surgery: a prospective study.

“…23 In one retrospective study early jaundice was seen in 13% of 232 patients undergoing open heart operations. 4 In a similar study 8.6% of 736 patients undergoing open heart surgery developed postoperative jaundice.5 There have, however, been only a few prospective inquiries into the incidence and causes of postoperative jaundice. The prospective study of Evans et a16 revealed a much higher incidence (21%) of postoperative jaundice in patients having major noncardiac operations.…”