Effect of liver cirrhosis on patient outcomes from open heart surgery

Abstract

Background We designed this prospective controlled study to evaluate the early postoperative outcomes in patients with liver cirrhosis (LC) after open heart surgery (OHS). Patients and methods Between May 2011 and February 2017, 120 patients with elective OHS were included and categorized into a control group (50%) and patients with LC (50%), who were further subdivided according to Child–Turcotte–Pugh (CTP) score into group CTP A (49 patients) and CTP B (11 patients). All preoperative demographic and clinical data in addition to operative and postoperative data were evaluated. Patients with CTP (class C) were excluded. Results Overall, 48 (40%) patients experienced a postoperative complication: 47% of group A cirrhosis, and 91% of group B cirrhosis (P < 0.001). Of these, 21% were cardiac complications, with the majority occurring in patients with CTP A (n = 19) and CTP B (n = 9). There were 12 (10%) postoperative deaths: four (7%) patients in the control group, four (8%) patients in CTP A group, and four (36%) patients in CTP B (P = 0.009). Factors associated with postoperative death included preoperative CTP classification (P = 0.01), European System for Cardiac Operative Risk Evaluation (0.01), New York Heart Association classification (P = 0.01), presence of ascites (0.02), a measurements of the right ventricular diameter (P = 0.03), ventilation time (P < 0.001), and postoperative chest tube drain output (0.04). Conclusion Patients with LC have a high incidence of morbidity and mortality after OHS compared with the control. The more the severity of LC, the more the complications and deaths. Patients with mild LC had acceptable outcome compared with others with advanced LC. The Child–Pugh score is more predictive of postoperative course than European System for Cardiac Operative Risk Evaluation.

Keywords

• liver cirrhosis
• open heart
• postoperative outcome