HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nobuhiko Hayashida Hideki Teshima Kazuyoshi Takagi Shigeaki Aoyagi Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hayashida, N. Articles by Aoyagi, S. Search for Related Content PubMed PubMed Citation Articles by Hayashida, N. Articles by Aoyagi, S. Related Collections Cardiac - other

Ann Thorac Surg 2004;77:500-505
© 2004 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Clinical outcome after cardiac operations in patients with cirrhosis

^a Department of Surgery, Kurume University, Kurume, Japan

Accepted for publication June 6, 2003.

^* Address reprint requests to Dr Hayashida, Department of Surgery, Kurume University, 67 Asahi-machi, Kurume, Japan 830-0011
e-mail: nobuhiko{at}med.kurume-u.ac.jp

BACKGROUND: To evaluate the clinical outcome after cardiac operations in patients with cirrhosis, a retrospective study was undertaken.

METHODS: Between 1989 and 2003, 18 patients with cirrhosis who underwent cardiac operations were identified. Their preoperative status and postoperative clinical results were assessed.

RESULTS: Ten patients were classified as having Child-Pugh class A cirrhosis, 7 as having class B cirrhosis, and 1 as having class C cirrhosis. Fifteen of 18 patients underwent cardiac surgery using cardiopulmonary bypass, and the remaining 3 patients with class B cirrhosis received coronary artery bypass grafting without cardiopulmonary bypass. In patients undergoing cardiopulmonary bypass, 60% of those with class A cirrhosis and 100% of those with class B cirrhosis and class C cirrhosis had postoperative major complications, including infection, respiratory failure, renal failure, bleeding, and gastrointestinal disorder. One of 3 patients (33%) with class B cirrhosis undergoing coronary artery bypass grafting without cardiopulmonary bypass had major complications. The overall postoperative mortality rate was 17%. Hospital mortality of patients with class A cirrhosis, class B cirrhosis, and class C cirrhosis undergoing cardiopulmonary bypass was 0%, 50%, and 100%, respectively. None of 3 patients with class B cirrhosis undergoing coronary artery bypass grafting without cardiopulmonary bypass died in this study.

CONCLUSIONS: Although the incidence of major complications was high, patients with Child-Pugh class A cirrhosis tolerated cardiac surgery satisfactorily. Patients with more advanced cirrhosis, however, may not be suitable for elective cardiac operations with cardiopulmonary bypass. Although our results are not conclusive, coronary artery bypass grafting without cardiopulmonary bypass can be an alternative therapeutic strategy for patients with advanced cirrhosis requiring surgical revascularization.

This article has been cited by other articles:

				R.-B. Hsu, C.-I Chang, F.-Y. Lin, N.-K. Chou, N.-H. Chi, S.-S. Wang, and S.-H. Chu Heart transplantation in patients with liver cirrhosis. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 307 - 312. [Abstract] [Full Text] [PDF]

				K. Iino, S. Tomita, S. Yamaguchi, and G. Watanabe Successful aortic valve replacement using dilutional ultrafiltration during cardiopulmonary bypass in a patient with Child-Pugh class C cirrhosis Interactive CardioVascular and Thoracic Surgery, April 1, 2008; 7(2): 331 - 332. [Abstract] [Full Text] [PDF]

				R.-B. Hsu, F.-Y. Lin, N.-K. Chou, W.-J. Ko, N.-H. Chi, and S.-S. Wang Heart transplantation in patients with extreme right ventricular failure Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 457 - 461. [Abstract] [Full Text] [PDF]

				S. Matsukuma, H. Yamaguchi, and M. Hamawaki Stanford Type A Aortic Dissection with Child B Liver Cirrhosis Asian Cardiovasc Thorac Ann, June 1, 2007; 15(3): e38 - e40. [Abstract] [Full Text] [PDF]

				Y. An and Y.-B. Xiao The preventative role of growth hormone on acute liver injury induced by cardiopulmonary bypass in a rat model Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1037 - 1043. [Abstract] [Full Text] [PDF]

				Y. An, Y.-B. Xiao, and Q.-J. Zhong Open-heart surgery in patients with liver cirrhosis Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1094 - 1098. [Abstract] [Full Text] [PDF]

				A. Ben Ari, E. Elinav, A. Elami, and I. Matot Off-pump coronary artery bypass grafting in a patient with Child class C liver cirrhosis awaiting liver transplantation Br. J. Anaesth., October 1, 2006; 97(4): 468 - 472. [Abstract] [Full Text] [PDF]

				A. Iwasaki, T. Shirakusa, K. Okabayashi, K. Inutsuka, S. Yoneda, S. Yamamoto, and T. Shiraisi Lung cancer surgery in patients with liver cirrhosis. Ann. Thorac. Surg., September 1, 2006; 82(3): 1027 - 1032. [Abstract] [Full Text] [PDF]

				J. N.K. Odim, J. Wu, H. Laks, A. Banerji, and S. Drant Cardiac Surgery in Children With End-Stage Liver Disease Awaiting Liver Transplantation Ann. Thorac. Surg., February 1, 2006; 81(2): 697 - 700. [Abstract] [Full Text] [PDF]

				C.-H. Lin, F.-Y. Lin, S.-S. Wang, H.-Y. Yu, and R.-B. Hsu Cardiac Surgery in Patients With Liver Cirrhosis Ann. Thorac. Surg., May 1, 2005; 79(5): 1551 - 1554. [Abstract] [Full Text] [PDF]

				R. Hanvesakul, R. Deshpande, C. S. Carr, and N. Akbar Aspergillus aortitis: a cause for aortic perforation in a patient following combined aortic valve surgery and liver transplantation Interactive CardioVascular and Thoracic Surgery, December 1, 2004; 3(4): 544 - 546. [Abstract] [Full Text] [PDF]

				E. A. Hessel II Abdominal Organ Injury After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 243 - 263. [Abstract] [PDF]