
DOI: 10.1055/s-0040-1715931
High Transaminases Following Cardiac Surgery: A Narrative Review

Abstract
Elevation of liver enzymes after cardiac surgery is encountered infrequently. Acute heart failure during and after surgery may be the culprit responsible for liver dysfunction. However, it may create clinical confusion whether acute liver dysfunction could induce some sort of cardiac dysfunction through mechanisms similar to those encountered in chronic liver disease. We searched through the Medline, Cochrane, and Embase databases up to January 2018. We included review articles, meta-analyses, and original trials on the elevation of liver enzymes after cardiac surgery, and combined the following MESH terms: “intensive care, “cardiac surgery,” “high liver enzymes,” “ischemia,” “left ventricular dysfunction,” and “critical illness.” Case reports were excluded. Language restrictions were not applied. References were examined for other potentially useful articles. We did not find any articles that supported the cardiac decompensation phenomenon after acute liver injury. In contrast, low-hepatic flow, hypoxemia, or pump-induced inflammation could induce hepatic dysfunction in acute settings after cardiac surgery. In conclusion, a rise in the transaminases following cardiac surgery would favor an ischemic etiology for the condition.
Publication History
Publication Date:
10 September 2020 (online)
© 2020. Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound ISCU. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
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References
- 1 Michalopoulos A, Alivizatos P, Geroulanos S. Hepatic dysfunction following cardiac surgery: determinants and consequences. Hepatogastroenterology 1997; 44 (15) 779-783
- 2 Soultati A, Dourakis A. Liver dysfunction in the intensive care unit. Ann Gastroenterol 2007; 18 (01) 35-45
- 3 Bernal W, Wendon J. Acute liver failure. N Engl J Med 2013; 369 (26) 2525-2534
- 4 Çağlı K, Başar FN, Tok D, Turak O, Başar Ö. How to interpret liver function tests in heart failure patients?. Turk J Gastroenterol 2015; 26 (03) 197-203
- 5 Møller S, Bernardi M. Interactions of the heart and the liver. Eur Heart J 2013; 34 (36) 2804-2811
- 6 Poelzl G, Auer J. Cardiohepatic syndrome. Curr Heart Fail Rep 2015; 12 (01) 68-78
- 7 Fouad YM, Yehia R. Hepato-cardiac disorders. World J Hepatol 2014; 6 (01) 41-54
- 8 Matsumori A. Hepatitis C virus infection and cardiomyopathies. Circ Res 2005; 96 (02) 144-147
- 9 Møller S, Henriksen JH. Cirrhotic cardiomyopathy: a pathophysiological review of circulatory dysfunction in liver disease. Heart 2002; 87 (01) 9-15
- 10 Henrion J, Descamps O, Luwaert R, Schapira M, Parfonry A, Heller F. Hypoxic hepatitis in patients with cardiac failure: incidence in a coronary care unit and measurement of hepatic blood flow. J Hepatol 1994; 21 (05) 696-703
- 11 Collins JD, Bassendine MF, Ferner R. et al. Incidence and prognostic importance of jaundice after cardiopulmonary bypass surgery. Lancet 1983; 1 (8334) 1119-1123
- 12 Okano N, Hiraoka H, Owada R. et al. Hepatosplanchnic oxygenation is better preserved during mild hypothermic than during normothermic cardiopulmonary bypass. Canadian journal of anaesthesia 2001 Nov 1; 48 (10) 1011-1014
- 13 Clemmesen O, Ott P, Larsen FS. Splanchnic metabolism in acute liver failure and sepsis. Curr Opin Crit Care 2004; 10 (02) 152-155
- 14 Jakob SM. Clinical review: splanchnic ischaemia. Crit Care 2002; 6 (04) 306-312
- 15 James PE, Madhani M, Roebuck W, Jackson SK, Swartz HM. Endotoxin-induced liver hypoxia: defective oxygen delivery versus oxygen consumption. Nitric Oxide 2002; 6 (01) 18-28
- 16 Hwang TL, Han ML. The changes of hepatic sinusoidal microcirculation and effects of nitric oxide synthase inhibitor during sepsis. Hepatogastroenterology 2003; 50 (49) 213-216
- 17 Fang C, Yoon S, Tindberg N, Järveläinen HA, Lindros KO, Ingelman-Sundberg M. Hepatic expression of multiple acute phase proteins and down-regulation of nuclear receptors after acute endotoxin exposure. Biochem Pharmacol 2004; 67 (07) 1389-1397
- 18 Lautt WW. Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. Am J Physiol 1985; 249 (5 Pt 1) G549-G556
- 19 Rasmussen A, Skak C, Kristensen M, Ott P, Kirkegaard P, Secher NH. Preserved arterial flow secures hepatic oxygenation during haemorrhage in the pig. J Physiol 1999; 516 (Pt 2) 539-548
- 20 Chen T, Zamora R, Zuckerbraun B, Billiar TR. Role of nitric oxide in liver injury. Curr Mol Med 2003; 3 (06) 519-526
- 21 Paxian M, Bauer I, Rensing H. et al. Recovery of hepatocellular ATP and “pericentral apoptosis” after hemorrhage and resuscitation. FASEB J 2003; 17 (09) 993-1002
- 22 Weisiger RA. Laboratory tests in liver disease. In: Bennet JC, Plum F. eds. Cecil Textbook of Medicine. 20th ed. London: WB Saunders Company; 1996: 759-762
- 23 McIntyre RC Jr, Pulido EJ, Bensard DD, Shames BD, Abraham E. Thirty years of clinical trials in acute respiratory distress syndrome. Crit Care Med 2000; 28 (09) 3314-3331
- 24 Jakob SM, Ruokonen E, Vuolteenaho O, Lampainen E, Takala J. Splanchnic perfusion during hemodialysis: evidence for marginal tissue perfusion. Crit Care Med 2001; 29 (07) 1393-1398
- 25 Romero-Bermejo FJ, Ruiz-Bailen M, Gil-Cebrian J, Huertos-Ranchal MJ. Sepsis-induced cardiomyopathy. Curr Cardiol Rev 2011; 7 (03) 163-183
- 26 Raman JS, Kochi K, Morimatsu H, Buxton B, Bellomo R. Severe ischemic early liver injury after cardiac surgery. Ann Thorac Surg 2002; 74 (05) 1601-1606
- 27 Lautt WW, Greenway CV. Conceptual review of the hepatic vascular bed. Hepatology 1987; 7 (05) 952-963
- 28 Wang TK, Stewart RA, Ramanathan T, Gamble G, White HD. Post-operative aspartate aminotransferase levels independently predict mortality after isolated coronary artery bypass grafting. IJC Metab Endocr 2015; 6: 31-35
- 29 Kurian GA, Paddikkala J. Biochemical changes in liver and kidney functions of patients subjected to revascularization in CABG procedure: role of magnesium supplementation. Appl Cardiopulm Pathophysiol 2010; 14: 29-39
- 30 UJ II. MI H. Effect of cardiopulmonary bypass on liver function in patients undergoing coronary artery bypass grafting. Biomedica 2015; 31 (01) 27
- 31 Shahbazi S, Panah A, Sahmeddini MA. Evaluation of factors influencing liver function test in on-pump coronary artery bypass graft surgery. Iran J Med Sci 2013; 38 (04) 308-313
- 32 Lefkowitch JH, Mendez L. Morphologic features of hepatic injury in cardiac disease and shock. J Hepatol 1986; 2 (03) 313-327
- 33 Henrion J, Minette P, Colin L, Schapira M, Delannoy A, Heller FR. Hypoxic hepatitis caused by acute exacerbation of chronic respiratory failure: a case-controlled, hemodynamic study of 17 consecutive cases. Hepatology 1999; 29 (02) 427-433
- 34 Ellenberg M, Osserman KE. The role of shock in the production of central liver cell necrosis. Am J Med 1951; 11 (02) 170-178
- 35 Alvarez AM, Mukherjee D. Liver abnormalities in cardiac diseases and heart failure. Int J Angiol 2011; 20 (03) 135-142
- 36 Cassidy WM, Reynolds TB. Serum lactic dehydrogenase in the differential diagnosis of acute hepatocellular injury. J Clin Gastroenterol 1994; 19 (02) 118-121
- 37 Parker MM, McCarthy KE, Ognibene FP, Parrillo JE. Right ventricular dysfunction and dilatation, similar to left ventricular changes, characterize the cardiac depression of septic shock in humans. Chest 1990; 97 (01) 126-131
- 38 Aboulnaga S, Mahfouz A, Ewila HA, et al. Postoperative cardiac surgery outcomes in a statin-native population. Anesthesia, Essays and Researches 2018;12(1):223
- 39 Sabzi F, Faraji R. Liver function tests following open cardiac surgery. J Cardiovasc Thorac Res 2015; 7 (02) 49-54