Is Cardiac Surgery Safe for Patients With Cirrhosis?
Patients with compensated cirrhosis who undergo cardiac surgery with cardiopulmonary bypass do not have greater post-operative mortality or morbidity than other patients who receive this surgery, according to the May issue of Clinical Gastroenterology and Hepatology.
Advanced liver disease is a significant risk factor for complications after cardiac surgery, but it is not clear what specific features determine this risk. Carole Macaron et al. evaluated the effects of cirrhosis on operative mortality and morbidity after cardiac surgery, adjusting for non–liver disease–related risk factors that were previously associated with bad outcomes from this surgery.
They compared outcomes and features of 54 patients with cirrhosis who underwent cardiac surgery with cardiopulmonary bypass with those of patients who underwent cardiac surgery at the same institution (controls).
Within 90 days after surgery, 4.6% of cirrhotic patients with Child–Turcotte–Pugh (CP) scores <8 and 70% of those with CP scores ≥8 died. The mortality of patients with CP score <8 was comparable to that of the controls.
Overall, cirrhotic patients stayed twice as long in the hospital after cardiac surgery compared with the matched controls (17 vs 9.7 days). However, patients with CP scores <8 had significantly shorter average length of hospital stay and were less likely to develop renal failure or require dialysis than patients with CP scores ≥8. The values were similar between patients with CP scores <8 and the controls.
Cirrhotic patients did not require prolonged ventilation and were as likely to develop respiratory failure as their matched controls. The authors propose that the prolonged hospital stays for cirrhotic patients resulted from postoperative hepatic decompensation, renal failure, or need for dialysis, rather than prolonged need for mechanical ventilation or need for pressor support, both of which require intensive care.
Macaron et al. conclude that patients with cirrhosis and CP scores <8 can safely undergo cardiac surgery with cardiopulmonary bypass, and that mild liver disease, measured objectively by CP score up to 7, is not a risk factor for death after cardiac surgery.
Read the article online.
Macaron C, Hanouneh IA, Suman A, et al. Safety of cardiac surgery for patients with cirrhosis and child–pugh scores less than 8. Clin Gastroenterol Hepatol 2012;10:535-539.
Read the accompanying editorial.
Giannini EG. Safety of cardiac surgery in cirrhotic patients: going to the heart of the matter. Clin Gastroenterol Hepatol 2012;10:450-451.