Jaundice after open heart surgery: a prospective study.

Abstract

One hundred and fifty four consecutive adult patients having cardiac surgery for a variety of cardiac lesions were evaluated prospectively for postoperative jaundice, those with a raised preoperative serum bilirubin concentration (greater than 34 ,mol/I or 2 mg/100 ml) being excluded. The incidence of early postoperative jaundice, as defined by a serum bilirubin concentration of 50 ,umoUl (3.0 mg/100 ml) or greater, was 23*4%. The jaundice was mild (bilirubin concentration 51-100 ,umoll (3-.06.0 mg/100 ml)) in 26 patients (16.9%) and moderate to severe (greater than 100 ,umol/I (6.0 mg/100 ml)) in 10 patients (6-5%). Important contributing factors were the preoperative severity of right heart failure (raised right atrial 'pressure at heart catheterisation) and hypotension or hypoxaemia and the amount of blood transfused during or shortly after surgery. Age, sex, underlying cardiac lesion, whether halothane was used, operative procedure, duration of cardiopulmonary bypass, and presence or absence of hepatitis B surface antigen were not predictive of postoperative jaundice.It has long been recognised that transient jaundice could appear after a surgical procedure' and that hepatic damage is particularly liable to follow cardiopulmonary bypass.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. The true incidence of early jaundice after open heart surgery is therefore still unclear and awaits further study.Furthermore, all studies on jaundice after open heart surgery were reported more than 10 years ago, when the medical care of patients undergoing open heart surgery was not as good as today, and when the hepatitis B surface antigen (HBsAg) was not recognised.7 HBsAg carriers are now known to harbour various liver lesions,8 which might contribute to the development of postoperative jaundice.9 It seemed therefore pertinent to investigate this prob-

Open-heart surgery in patients with liver cirrhosis

“…Nonsurvivors presented with significantly higher preoperative bilirubin levels. Patients with hepatic dysfunction, defined as the presence of preoperative jaundice associated with an elevated serum bilirubin above 3 mg/l, experienced a much higher mortality rate compared with the control group [23,24]. In patients with end-stage cardiac failure requiring ventricular assist device, a low preoperative bilirubin level has been shown to be the only significant predictor for survival [25].…”

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.…”

“…The mortality can reach 85%-90% once the postoperative jaundice progresses to hepatic failure [4][5][6][7] . On the other hand, for patients with preoperative cirrhosis of liver, mortality of CPB surgery can reach 31% [8] .…”

Frequency, Risk Factors and Prognosis of Postoperative Hyperbilirubinemia after Heart Valve Surgery

“…One study reported that postoperative hyperbilirubinemia is associated with mortality, while others reported no association between elevated bilirubin and mortality [5]. Its incidence being associated with certain types of cardiac operations is another issue that has been considered.…”

“…Despite recent advances in surgical techniques and perioperative management, the incidence of postoperative hyperbilirubinemia after open-heart surgery is estimated to be nearly 20% [1,2,3,4,5,6,7,8,9,10], which has been consistent since the first report in 1967 [1,2]. Previous studies have suggested a number of possible risk factors underlying the development of postoperative hyperbilirubinemia, including age, heart failure [10,11], cardiopulmonary bypass time [9,10], transfusion [6,9], hemolysis [6] and sepsis [1].…”