Hepatic Coma After Open Heart Surgery

Dm, Hill; Se, Warren; Ja, Mitas; Ah, Swerdlin

doi:10.1097/00007611-198007000-00023

Cited by 17 publications

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“…For patients with portal hypertension, an increased proportion of the total hepatic blood flow is supplied by the hepatic artery. Therefore, a decrease in arterial pressure or arterial oxygenation is more likely to produce further hepatic damage in these patients as compared with normal patients [19]. In the present study, further hepatic dysfunction was observed in six patients after long CPB time.…”

Section: Discussionmentioning

confidence: 42%

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Open-heart surgery in patients with liver cirrhosis

Zhong

2007

European Journal of Cardio-Thoracic Surgery

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Background: This retrospective study was designed to examine morbidity and mortality rates and to find predictors of outcome in patients with liver cirrhosis (LC) undergoing open-heart surgery. Methods: Between May 1996 and June 2005, 24 patients with LC underwent an open-heart surgery in our institution. Results: There were 14 females and 10 males. Their age ranged from 36 to 72 (average 53 AE 13) years. Seventeen cases were classified as having Child-Pugh class A cirrhosis, six as having class B cirrhosis, and one as having class C cirrhosis. The mean cardiopulmonary bypass (CPB) time and the cross-clamp time were 160 AE 53 and 90 AE 42 min, respectively. In the first 24 h after operation, the mean chest tube output was 1080 AE 320 ml. Mean duration of mechanical ventilation was 32 AE 22 h and mean intensive care unit stay time was 11 AE 8 days. Sixtysix percent of the patients experienced significant morbidity. Fifty-three percent of patients with class A cirrhosis and 100% of those with class B and C cirrhosis suffered postoperative complications. The overall mortality rate was 25%. Postoperative mortality of patients with Child-Pugh class A cirrhosis, class B cirrhosis, and C cirrhosis were 6, 67, and 100%, respectively. Preoperative serum total bilirubin (TB), cholinesterase (ChE), and CPB time were defined as predictors to differentiate survivors and nonsurvivors. Conclusion: Child-Pugh class is related to morbidity and mortality after open-heart surgery in patients with LC. But CPB surgery is associated with higher morbidity and mortality in patients with advanced LC. The increased serum level of TB and the low serum concentration of ChE preoperatively, and the prolonged CPB time were found to be predictors of outcome in patients with LC undergoing open heart surgery. #

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Section: Discussionmentioning

confidence: 42%

“…Hill et al reported two patients with fulminant hepatic failure after cardiac surgery [19]. They mentioned that prolonged CPB time during operation caused postoperative liver dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Open-heart surgery in patients with liver cirrhosis

Zhong

2007

European Journal of Cardio-Thoracic Surgery

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“…Hill et al [22] reported 2 patients with fulminant hepatic failure after cardiac surgery. These authors mentioned that prolonged CPB time during the operation caused postoperative liver dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Open-Heart Surgery in Patients with Liver Cirrhosis: Indications, Risk Factors, and Clinical Outcomes

Zhong³

2007

Eur Surg Res

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Background: Because of recent advances in cardiopulmonary bypass (CPB) surgery, there are broadened indications to approach patients with a high operative risk. Meanwhile, there is an increasing number of patients with severe liver dysfunction subjected to open-heart surgery. This retrospective study was designed to evaluate the operative indications and clinical outcomes in patients with liver cirrhosis (LC) undergoing open-heart surgery. In addition, determinants influencing their prognosis were assessed. Patients and Methods: Between May 1996 and June 2005, 24 patients with LC underwent CPB open-heart surgery in our institution. The preoperative severity of the LC was determined according to the Child-Pugh classification. Their perioperative data were analyzed. Several perioperative factors were compared by multivariate logistic regression analysis between survivors and nonsurvivors to determine possible risk factors contributing to mortality. Results:There were 14 females and 10 males. Their age ranged from 36 to 72 (mean 53 ± 13) years. Seventeen cases were classified as having Child-Pugh class A LC, 6 as having Child-Pugh class B, and 1 as having Child-Pugh class C LC. All patients underwent CPB surgery. The mean operation time and the cross-clamp time were 160 ± 53 and 90 ± 42 min, respectively. During the first 24 h after the operation, the mean chest tube output was 1,080 ± 320 ml. The mean duration of mechanical ventilation was 32 ± 22 h, and the mean intensive care unit stay was 11 ± 8 days. Sixty-six percent of the patients experienced significant morbidity. Fifty-three percent of the patients with Child-Pugh class A LC and 100% of those with Child-Pugh class B and C LC suffered postoperative complications. The overall mortality rate was 25%. The postoperative mortality rates of the patients with Child-Pugh class A, B, and C LC were 6, 67, and 100%, respectively. Preoperative serum total bilirubin and cholinesterase levels and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values along with CPB time were identified as the important predictors to differentiate between survivors and nonsurvivors by multivariate logistic regression analysis. Conclusions: The Child-Pugh class is associated with hepatic decompensation and mortality after open-heart CPB surgery in patients with LC. Such surgery can be performed safely in patients with a Child-Pugh class A LC. But cardiac interventions using CPB in patients with more advanced LC are associated with high mortality and morbidity rates. The preoperative total plasma bilirubin and cholinesterase concentrations as well as the EuroSCORE along with the CPB time are identified as statistically significant predictors of mortality after open-heart surgery in patients with LC. Our findings indicate that patients with chronic liver disease scheduled for open-heart surgery should be carefully evaluated before the operation and that the CPB duration should be as short as possible.

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“…In patients awaiting cardiac surgery, heart failure may already have led to hepatic congestion and a reduction in liver functionl,2; cardiopulmonary bypass may then be followed by further impairment.3--5 Although serious hepatic injury is uncommon, it does occur,~-9 but even mild injury is of concern and may indeed be a much more widespread problem than often realized. 4,5,[9][10][11] The aetiology of hepatic injury occurring during at UNIV OF PITTSBURGH on June 2, 2015 prf.sagepub.com Downloaded from cardiac surgery is multifactorial, with complement activation playing an important role.l2 However, as cardiopulmonary bypass is known to redistribute organ blood flow, [13][14][15][16] it is likely that the initial insult stems from a period of poor organ perfusion, 7,8,[17][18][19]; the risk of this leading to postoperative hepatic impairment being greater in those patients with pre-existing dysfunction, however mild that may be. ig…”

Section: Introductionmentioning

confidence: 99%

The effects of congenital heart disease and cardiac surgery on I iver blood flow in children

1995

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Children with congenital heart disease may have some degree of hepatic impairment, with further impairment developing shortly after surgical correction of the cardiac defect. The redistribution of organ blood flow that occurs during cardiopulmonary bypass implicates ischaemia as one of the principal causes of injury. The aim of this study was to measure liver blood flow in children with congenital heart disease and to determine both the effects of cardiopulmonary bypass and the consequences of corrective surgery. Indocyanine green clearance and auricular densitometry, were used in 31 children. In 83% we demonstrated a reduced liver blood flow, with a mean percentage disappearance rate (PDR) of 12.9% (SEM +/- 1.2). This finding was unrelated to the patient's age, the type of congenital heart defect or the presence or absence of cyanosis. During cardiopulmonary bypass, hepatic perfusion was further reduced in 77% of children, by an average of 67%, out of proportion with the iatrogenic reduction in total body flow. Six hours after surgery, liver blood flow had increased significantly above preoperative levels (p < 0.001; t-test) to approximately normal values with a mean PDR of 20.4% (SEM +/- 1.5).

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Hepatic Coma After Open Heart Surgery

Cited by 17 publications

References 0 publications

Open-heart surgery in patients with liver cirrhosis

Open-heart surgery in patients with liver cirrhosis

Open-Heart Surgery in Patients with Liver Cirrhosis: Indications, Risk Factors, and Clinical Outcomes

The effects of congenital heart disease and cardiac surgery on I iver blood flow in children

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