Predictive Risk Factors for Patients With Cirrhosis Undergoing Heart Surgery

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Abstract

Background.

Empiric experiences suggest higher mortality and complication risk for patients with cirrhosis of the liver after cardiac surgery. However, cirrhosis is not considered a risk factor in either the EuroSCORE or The Society of Thoracic Surgeons score. We report a large single-center experience of patients with cirrhosis undergoing cardiac surgery with extracorporeal circulation and aimed to evaluate the severity of cirrhosis as a predictor of outcome.

Methods.

During 2001 and 2011, we operated on 109 consecutive patients (average age, 64 years; 82 male) diagnosed for cirrhosis with cardiopulmonary bypass for different indications. Thirty-day mortality and long-term mortality were set as primary study end points.

Results.

Thirty-day mortality was 26%, and 5-year survival was 19%. Patients categorized as Child-Turcotte-Pugh (CHILD) C (n = 6; 67% 30-day survival; 0% 5-year survival) and B (n = 30; 60%; 5%) had worse 30-day and 5-year survival compared with patients categorized as CHILD A (n = 73; 80%; 25%). For 30-day mortality, preoperative EuroSCORE (p= 0.015), model for end-stage liver disease (MELD) score (p= 0.006), albumin (p= 0.023), total protein (p= 0.01), and myocardial infarction (p= 0.049) revealed significant differences between survivors and nonsurvivors. Multivariate logistic regression identified only MELD score (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.03 to 1.23;p= 0.011) and total protein (OR, 0.97; 95% CI, 0.95 to 1;p= 0.049) were connected with increased 30-day mortality. Cox regression analysis revealed EuroSCORE (OR, 1.02; 95% CI, 1.01 to 1.03;p< 0.0001) and MELD (OR, 1.06; 95% CI, 1.01 to 1.12;p= 0.016) predicting the overall mortality. Receiver operating characteristic analysis indicated significant predictive power of MELD (p= 0.001) and EuroSCORE (p= 0.027) for 30-day mortality.

Conclusions.

Patients with cirrhosis undergoing heart surgery with extracorporeal circulation have a poor prognosis. Several preoperative factors are related to outcome. EuroSCORE and MELD score may help to evaluate operation risk and indication.

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