Early and late outcomes of cardiac operations in patients with cirrhosis
December's European Journal of Gastroenterology & Hepatology investigates early and late outcomes of cardiac operations in patients with cirrhosis.
Patients with liver cirrhosis are considered as high-risk population for cardiac surgery.
Dr Felix Gundling and colleagues reviewed mortality and mid-term outcome of patients with liver cirrhosis requiring coronary artery bypass graft, valve replacement, or combined procedures.
Group 1 included 47 patients with liver cirrhosis who were operated for coronary artery bypass graft, aortic valve replacement/mitral valve replacement, coronary artery bypass graft/valve replacement or aortic dissection.
The research team classified 33 patients were classified as Child-Pugh class A, and 14 patients as
Child-Pugh class B cirrhosis.
Postoperative complications/mortality were analyzed retrospectively, and compared with a propensity-score pair-matched control group of 47 patients in Group 2.
Follow-up ranged from 0.1 to 12 years and was complete for 100%.
30-day mortality was 19% in Group 1 versus 9% in Group 2
European Journal of Gastroenterology & Hepatology
Necessity of blood products was higher in Group 1.
Necessity of blood products was higher in Group 1.
The researchers found that chest-tube output and re-exploration rate were slightly accelerated.
Ventilation time and ICU-stay was prolonged.
The research team found that 30-day mortality was 19% in Group 1 versus 9% in Group 2.
In Child-B operative risk was 16-fold higher than in Child-A cirrhosis.
Postcardiotomy syndrome and pleurisy were more frequent in the cirrhosis group.
Actuarial survival after 3, 5 and 8 years was 79%, 76%, and 70% in Group 1 versus 89%, 86%, and 86% in Group 2, respectively.
Dr Gundling's, "Cardiac surgery can be performed safely in patients with Child-Pugh class A and selected patients with Child-Pugh class B cirrhosis."
"Mid-term survival-rates within 8 years were not significantly different compared with a propensity-score pair-matched control group without cirrhosis."
25 November 2010
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