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Thorac Cardiovasc Surg 2015; 63(01): 058-066
DOI: 10.1055/s-0034-1389084
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Impact of Hepatic Cirrhosis on Outcome in Adult Cardiac Surgery

Ioannis Dimarakis
1   Department of Cardiothoracic Surgery, University Hospital South Manchester, Manchester, United Kingdom
,
Stuart Grant
1   Department of Cardiothoracic Surgery, University Hospital South Manchester, Manchester, United Kingdom
,
Rebecca Corless
2   Department of Clinical Oncology Research, University Hospital South Manchester, Manchester, United Kingdom
,
Theodore Velissaris
3   Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
,
Martin Prince
4   Department of Gastroenterology, Manchester Royal Infirmary, Manchester, United Kingdom
,
Ben Bridgewater
1   Department of Cardiothoracic Surgery, University Hospital South Manchester, Manchester, United Kingdom
,
George Asimakopoulos
5   Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol, Bristol, United Kingdom
› Author Affiliations
Further Information

Publication History

21 April 2014

04 July 2014

Publication Date:
07 October 2014 (online)

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Abstract

Increasing prevalence of hepatic disease is likely to translate in a growing number of patients with significant hepatic disease requiring cardiac surgery. Available cardiac risk stratification models do not address the risk associated with hepatic disease. However, weighted mean mortality rates based on previous studies of cardiac surgery in patients with hepatic disease demonstrate operative mortality rates that range from 9.88% (standard deviation [SD] 9.69) for patients in Child–Turcotte–Pugh (CTP) class A cirrhosis to 69.23% (SD 28.55) for patients with CTP class C cirrhosis. This review comprehensively appraises the pathophysiology of hepatic disease, reported clinical outcomes and considerations for risk stratification.

Keywords

liver diseases/cirrhosis - risk - outcomes
 

  • References

  • 1 Abramov D, Tamariz MG, Fremes SE , et al. Trends in coronary artery bypass surgery results: a recent, 9-year study. Ann Thorac Surg 2000; 70 (1) 84-90
    CrossrefPubMedGoogle Scholar
  • 2 Aldea GS, Mokadam NA, Melford Jr R , et al. Changing volumes, risk profiles, and outcomes of coronary artery bypass grafting and percutaneous coronary interventions. Ann Thorac Surg 2009; 87 (6) 1828-1838
    CrossrefPubMedGoogle Scholar
  • 3 Hickey GL, Grant SW, Murphy GJ , et al. Dynamic trends in cardiac surgery: why the logistic EuroSCORE is no longer suitable for contemporary cardiac surgery and implications for future risk models. Eur J Cardiothorac Surg 2013; 43 (6) 1146-1152
    CrossrefPubMedGoogle Scholar
  • 4 Csikesz NG, Nguyen LN, Tseng JF, Shah SA. Nationwide volume and mortality after elective surgery in cirrhotic patients. J Am Coll Surg 2009; 208 (1) 96-103
    CrossrefPubMedGoogle Scholar
  • 5 Younossi ZM, Stepanova M, Afendy M , et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol 2011; 9 (6) 524-530 , e1, quiz e60
    CrossrefPubMedGoogle Scholar
  • 6 Keeling AN, Flaherty JD, Davarpanah AH , et al. Coronary multidetector computed tomographic angiography to evaluate coronary artery disease in liver transplant candidates: methods, feasibility and initial experience. J Cardiovasc Med (Hagerstown) 2011; 12 (7) 460-468
    CrossrefPubMedGoogle Scholar
  • 7 Sanyal AJ, Bosch J, Blei A, Arroyo V. Portal hypertension and its complications. Gastroenterology 2008; 134 (6) 1715-1728
    CrossrefPubMedGoogle Scholar
  • 8 Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodés J. Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988; 8 (5) 1151-1157
    CrossrefPubMedGoogle Scholar
  • 9 Angeli P, Merkel C. Pathogenesis and management of hepatorenal syndrome in patients with cirrhosis. J Hepatol 2008; 48 (Suppl. 01) S93-S103
    PubMedGoogle Scholar
  • 10 Zardi EM, Abbate A, Zardi DM , et al. Cirrhotic cardiomyopathy. J Am Coll Cardiol 2010; 56 (7) 539-549
    CrossrefPubMedGoogle Scholar
  • 11 Møller S, Krag A, Henriksen JH, Bendtsen F. Pathophysiological aspects of pulmonary complications of cirrhosis. Scand J Gastroenterol 2007; 42 (4) 419-427
    CrossrefPubMedGoogle Scholar
  • 12 Tripodi A, Primignani M, Chantarangkul V , et al. An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis. Gastroenterology 2009; 137 (6) 2105-2111
    CrossrefPubMedGoogle Scholar
  • 13 Lisman T, Caldwell SH, Burroughs AK , et al; Coagulation in Liver Disease Study Group. Hemostasis and thrombosis in patients with liver disease: the ups and downs. J Hepatol 2010; 53 (2) 362-371
    CrossrefPubMedGoogle Scholar
  • 14 Lisman T, Porte RJ. Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences. Blood 2010; 116 (6) 878-885
    CrossrefPubMedGoogle Scholar
  • 15 Rios R, Sangro B, Herrero I, Quiroga J, Prieto J. The role of thrombopoietin in the thrombocytopenia of patients with liver cirrhosis. Am J Gastroenterol 2005; 100 (6) 1311-1316
    CrossrefPubMedGoogle Scholar
  • 16 Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg 1964; 1: 1-85
    PubMedGoogle Scholar
  • 17 Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60 (8) 646-649
    CrossrefPubMedGoogle Scholar
  • 18 Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000; 31 (4) 864-871
    CrossrefPubMedGoogle Scholar
  • 19 Kamath PS, Kim WR ; Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology 2007; 45 (3) 797-805
    CrossrefPubMedGoogle Scholar
  • 20 Costa BP, Sousa FC, Serôdio M, Carvalho C. Value of MELD and MELD-based indices in surgical risk evaluation of cirrhotic patients: retrospective analysis of 190 cases. World J Surg 2009; 33 (8) 1711-1719
    CrossrefPubMedGoogle Scholar
  • 21 Kim HJ, Lee HW. Important predictor of mortality in patients with end-stage liver disease. Clin Mol Hepatol 2013; 19 (2) 105-115
    CrossrefPubMedGoogle Scholar
  • 22 Befeler AS, Palmer DE, Hoffman M, Longo W, Solomon H, Di Bisceglie AM. The safety of intra-abdominal surgery in patients with cirrhosis: model for end-stage liver disease score is superior to Child-Turcotte-Pugh classification in predicting outcome. Arch Surg 2005; 140 (7) 650-654 , discussion 655
    CrossrefPubMedGoogle Scholar
  • 23 Neeff H, Mariaskin D, Spangenberg HC, Hopt UT, Makowiec F. Perioperative mortality after non-hepatic general surgery in patients with liver cirrhosis: an analysis of 138 operations in the 2000s using Child and MELD scores. J Gastrointest Surg 2011; 15 (1) 1-11
    CrossrefPubMedGoogle Scholar
  • 24 Farnsworth N, Fagan SP, Berger DH, Awad SS. Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients. Am J Surg 2004; 188 (5) 580-583
    CrossrefPubMedGoogle Scholar
  • 25 del Olmo JA, Flor-Lorente B, Flor-Civera B , et al. Risk factors for nonhepatic surgery in patients with cirrhosis. World J Surg 2003; 27 (6) 647-652
    CrossrefPubMedGoogle Scholar
  • 26 Ghaferi AA, Mathur AK, Sonnenday CJ, Dimick JB. Adverse outcomes in patients with chronic liver disease undergoing colorectal surgery. Ann Surg 2010; 252 (2) 345-350
    CrossrefPubMedGoogle Scholar
  • 27 Demetriades D, Constantinou C, Salim A, Velmahos G, Rhee P, Chan L. Liver cirrhosis in patients undergoing laparotomy for trauma: effect on outcomes. J Am Coll Surg 2004; 199 (4) 538-542
    CrossrefPubMedGoogle Scholar
  • 28 Marrocco-Trischitta MM, Kahlberg A, Astore D, Tshiombo G, Mascia D, Chiesa R. Outcome in cirrhotic patients after elective surgical repair of infrarenal aortic aneurysm. J Vasc Surg 2011; 53 (4) 906-911
    CrossrefPubMedGoogle Scholar
  • 29 Teh SH, Nagorney DM, Stevens SR , et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology 2007; 132 (4) 1261-1269
    CrossrefPubMedGoogle Scholar
  • 30 Matthews JC, Pagani FD, Haft JW, Koelling TM, Naftel DC, Aaronson KD. Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality. Circulation 2010; 121 (2) 214-220
    CrossrefPubMedGoogle Scholar
  • 31 Samuel D. MELD-Na as a prognostic score for cirrhotic patients: Hyponatremia and ascites are back in the game. J Hepatol 2009; 50 (4) 836-838
    CrossrefPubMedGoogle Scholar
  • 32 Bureau C, Métivier S, D'Amico M , et al. Serum bilirubin and platelet count: a simple predictive model for survival in patients with refractory ascites treated by TIPS. J Hepatol 2011; 54 (5) 901-907
    CrossrefPubMedGoogle Scholar
  • 33 Morisaki A, Hosono M, Sasaki Y , et al. Risk factor analysis in patients with liver cirrhosis undergoing cardiovascular operations. Ann Thorac Surg 2010; 89 (3) 811-817
    CrossrefPubMedGoogle Scholar
  • 34 Sebastiani G, Tempesta D, Fattovich G , et al. Prediction of oesophageal varices in hepatic cirrhosis by simple serum non-invasive markers: Results of a multicenter, large-scale study. J Hepatol 2010; 53 (4) 630-638
    CrossrefPubMedGoogle Scholar
  • 35 Hirata N, Sawa Y, Matsuda H. Predictive value of preoperative serum cholinesterase concentration in patients with liver dysfunction undergoing cardiac surgery. J Card Surg 1999; 14 (3) 172-177
    CrossrefPubMedGoogle Scholar
  • 36 Murashita T, Komiya T, Tamura N , et al. Preoperative evaluation of patients with liver cirrhosis undergoing open heart surgery. Gen Thorac Cardiovasc Surg 2009; 57 (6) 293-297
    CrossrefPubMedGoogle Scholar
  • 37 Tripodi A, Chantarangkul V, Primignani M , et al. Point-of-care coagulation monitors calibrated for the international normalized ratio for cirrhosis (INRliver) can help to implement the INRliver for the calculation of the MELD score. J Hepatol 2009; 51 (2) 288-295
    CrossrefPubMedGoogle Scholar
  • 38 Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology 1999; 90 (1) 42-53
    CrossrefPubMedGoogle Scholar
  • 39 Lopez-Delgado JC, Esteve F, Javierre C , et al. Short-term independent mortality risk factors in patients with cirrhosis undergoing cardiac surgery. Interact Cardiovasc Thorac Surg 2013; 16 (3) 332-338
    CrossrefPubMedGoogle Scholar
  • 40 Friedman LS. Surgery in the patient with liver disease. Trans Am Clin Climatol Assoc 2010; 121: 192-204 , discussion 205
    PubMedGoogle Scholar
  • 41 Shaheen AA, Kaplan GG, Hubbard JN, Myers RP. Morbidity and mortality following coronary artery bypass graft surgery in patients with cirrhosis: a population-based study. Liver Int 2009; 29 (8) 1141-1151
    CrossrefPubMedGoogle Scholar
  • 42 Marui A, Kimura T, Tanaka S , et al; CREDO-Kyoto Investigators. Coronary revascularization in patients with liver cirrhosis. Ann Thorac Surg 2011; 91 (5) 1393-1399
    CrossrefPubMedGoogle Scholar
  • 43 El-Tahan MR, Hamad RA, Ghoneimy YF, El Shehawi MI, Shafi MA. A prospective, randomized study of the effects of continuous ultrafiltration in hepatic patients after cardiac valve surgery. J Cardiothorac Vasc Anesth 2010; 24 (1) 63-68
    CrossrefPubMedGoogle Scholar
  • 44 Klemperer JD, Ko W, Krieger KH , et al. Cardiac operations in patients with cirrhosis. Ann Thorac Surg 1998; 65 (1) 85-87
    CrossrefPubMedGoogle Scholar
  • 45 Bizouarn P, Ausseur A, Desseigne P , et al. Early and late outcome after elective cardiac surgery in patients with cirrhosis. Ann Thorac Surg 1999; 67 (5) 1334-1338
    CrossrefPubMedGoogle Scholar
  • 46 Hayashida N, Shoujima T, Teshima H , et al. Clinical outcome after cardiac operations in patients with cirrhosis. Ann Thorac Surg 2004; 77 (2) 500-505
    CrossrefPubMedGoogle Scholar
  • 47 Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD. Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child-Pugh and MELD scores. Clin Gastroenterol Hepatol 2004; 2 (8) 719-723
    CrossrefPubMedGoogle Scholar
  • 48 Lin CH, Lin FY, Wang SS, Yu HY, Hsu RB. Cardiac surgery in patients with liver cirrhosis. Ann Thorac Surg 2005; 79 (5) 1551-1554
    CrossrefPubMedGoogle Scholar
  • 49 Filsoufi F, Salzberg SP, Rahmanian PB , et al. Early and late outcome of cardiac surgery in patients with liver cirrhosis. Liver Transpl 2007; 13 (7) 990-995
    CrossrefPubMedGoogle Scholar
  • 50 An Y, Xiao YB, Zhong QJ. Open-heart surgery in patients with liver cirrhosis: indications, risk factors, and clinical outcomes. Eur Surg Res 2007; 39: 67-74
    PubMedGoogle Scholar
  • 51 Ailawadi G, Lapar DJ, Swenson BR , et al. Model for end-stage liver disease predicts mortality for tricuspid valve surgery. Ann Thorac Surg 2009; 87 (5) 1460-1467 , discussion 1467–1468
    CrossrefPubMedGoogle Scholar
  • 52 Gundling F, Seidl H, Gansera L , et al. Early and late outcomes of cardiac operations in patients with cirrhosis: a retrospective survival-rate analysis of 47 patients over 8 years. Eur J Gastroenterol Hepatol 2010; 22 (12) 1466-1473
    PubMedGoogle Scholar
  • 53 Thielmann M, Mechmet A, Neuhäuser M , et al. Risk prediction and outcomes in patients with liver cirrhosis undergoing open-heart surgery. Eur J Cardiothorac Surg 2010; 38 (5) 592-599
    CrossrefPubMedGoogle Scholar
  • 54 Sugimura Y, Toyama M, Katoh M, Kato Y, Hisamoto K. Analysis of open heart surgery in patients with liver cirrhosis. Asian Cardiovasc Thorac Ann 2012; 20 (3) 263-268
    CrossrefPubMedGoogle Scholar
  • 55 Vanhuyse F, Maureira P, Portocarrero E , et al. Cardiac surgery in cirrhotic patients: results and evaluation of risk factors. Eur J Cardiothorac Surg 2012; 42 (2) 293-299
    CrossrefPubMedGoogle Scholar
  • 56 Macaron C, Hanouneh IA, Suman A, Lopez R, Johnston D, Carey WW. Safety of cardiac surgery for patients with cirrhosis and Child-Pugh scores less than 8. Clin Gastroenterol Hepatol 2012; 10 (5) 535-539
    CrossrefPubMedGoogle Scholar
  • 57 Arif R, Seppelt P, Schwill S , et al. Predictive risk factors for patients with cirrhosis undergoing heart surgery. Ann Thorac Surg 2012; 94 (6) 1947-1952
    CrossrefPubMedGoogle Scholar
  • 58 Shahian DM, O'Brien SM, Filardo G , et al; Society of Thoracic Surgeons Quality Measurement Task Force. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1—coronary artery bypass grafting surgery. Ann Thorac Surg 2009; 88 (1, Suppl): S2-S22
    CrossrefPubMedGoogle Scholar
  • 59 Nashef SA, Roques F, Sharples LD , et al. EuroSCORE II. Eur J Cardiothorac Surg 2012; 41 (4) 734-744 , discussion 744–745
    CrossrefPubMedGoogle Scholar
  • 60 D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006; 44 (1) 217-231
    CrossrefPubMedGoogle Scholar
  • 61 Francoz C, Glotz D, Moreau R, Durand F. The evaluation of renal function and disease in patients with cirrhosis. J Hepatol 2010; 52 (4) 605-613
    CrossrefPubMedGoogle Scholar
  • 62 Cholongitas E, Senzolo M, Patch D , et al. Risk factors, sequential organ failure assessment and model for end-stage liver disease scores for predicting short term mortality in cirrhotic patients admitted to intensive care unit. Aliment Pharmacol Ther 2006; 23 (7) 883-893
    CrossrefPubMedGoogle Scholar
  • 63 Bhangui P, Laurent A, Amathieu R, Azoulay D. Assessment of risk for non-hepatic surgery in cirrhotic patients. J Hepatol 2012; 57 (4) 874-884
    CrossrefPubMedGoogle Scholar
  • 64 Giannini EG. Safety of cardiac surgery in cirrhotic patients: going to the heart of the matter. Clin Gastroenterol Hepatol 2012; 10 (5) 450-451
    CrossrefPubMedGoogle Scholar
  • 65 Telem DA, Schiano T, Goldstone R , et al. Factors that predict outcome of abdominal operations in patients with advanced cirrhosis. Clin Gastroenterol Hepatol 2010; 8 (5) 451-457 , quiz e58
    CrossrefPubMedGoogle Scholar
  • 66 Solà E, Ginès P. Renal and circulatory dysfunction in cirrhosis: current management and future perspectives. J Hepatol 2010; 53 (6) 1135-1145
    CrossrefPubMedGoogle Scholar