Abstract 13058: Liver Cirrhosis in Patients Undergoing Heart Surgery with Use of Extracorporeal Circulation: Survival Can Be Predicted by Several Preoperative Factors and Classifications
Background: Empirical experiences suggest higher mortality and perioperative complication risk for patients with liver cirrhosis (LC) after cardiac surgery. However, LC is neither in euroSCORE (eS) nor in STS Score considered as risk factor for poor outcome. Here we report the so far largest single centre experience with LC undergoing cardiac surgery with extracorporeal circulation aimed to judge the severity of LC as a predictor of outcome.
Methods: During 2001 and 2011, we operated on 109 consecutive patients with diagnosed LC with cardiopulmonary bypass for different indications. Several preoperative predictors and postoperative data, as well as preoperative eS, MELD score and CTP classification were ascertained. 30-day mortality and long-term mortality were set as primary study endpoints. Perioperative morbidity was analysed. Influence of severity of LC in regard to CTP-classification was compared.
Results: Average age of patients was 63 years, 83 (76%) were male. Thirty-day mortality was 26%, five year survival was 19%. CTP C (n=6; 67%; 0%) and CTP B (n=30; 60%; 5,6%) categorised patients had worse 30-day and five-year survival compared to CTP A (n=73; 80%; 23%). For 30-day mortality, preoperative eS (p=0,017), MELD score (p=0,006), albumin (p=0,023), total protein (p= 0,01), ascites (p=0,0462), and myocardial infarction (p=0,045) revealed significant difference between survivors and non-survivors. Univariate predictors are eS (p=0.008), MELD score (p=0.002), bilirubin (p=0.034), albumin (p=0.009) and total protein (p=0.01). Multivariate logistic regression identified only MELD score (OR=1.12; CI 95%=1.03-1.23; p=0.011) and total protein (0.97; 0.95-1; p=0,049) connected with increased 30-day mortality. Cox regression revealed eS (1.02; 1.01-1.03;p<0,0001) and MELD (1,06; 1,01-1,12; p=0,016) predicting the overall mortality. Receiver operating characteristic curve (ROC) analysis indicates significant predictive power of MELD (p=0.001) and eS (p=0.027) for 30-day mortality.
Conclusions: Patients with liver cirrhosis undergoing heart surgery with extracorporeal circulation have poor prognosis. Several preoperative factors help to predict outcome. EuroSCORE and MELD may help to judge the indication for operation.
- © 2011 by American Heart Association, Inc.