Cardiac surgery in patients with liver cirrhosis – Uncalculatable risk or justified therapy? A retrospective survival-rate analysis of 47 patients within 8 years

F Gundling; H Seidl; T Schuster; E Hoffmann; BM Kemkes; W Eichinger; B Gansera; F Schmidtler; W Schepp

doi:10.1055/s-0030-1267660

Zeitschrift für Gastroenterologie, Inhaltsverzeichnis

Cardiac surgery in patients with liver cirrhosis – Uncalculatable risk or justified therapy? A retrospective survival-rate analysis of 47 patients within 8 years

F Gundling ¹, H Seidl ¹, T Schuster ², E Hoffmann ³, BM Kemkes ⁴, W Eichinger ⁴, B Gansera ⁴, F Schmidtler ³, W Schepp ¹

¹Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Munich, Germany
²Institut für medizinische Statistik und Epidemiologie, Technical University of Munich, University of Munich, Munich, Germany
³Department of Cardiology, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Munich, Germany
⁴Department of Cardiovascular Surgery, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Munich, Germany

Abstract

Objectives: Patients with liver cirrhosis (LC) are considered as high risk population for cardiac surgery. Aim of this study was to review mortality and mid-term-outcome of patients with liver cirrhosis requiring coronary-artery-bypass grafting (CABG), valve-replacement or combined procedures.

Methods: Between 7/97 and 12/06 47 patients (mean age 65.4±11.7 years) with liver cirrhosis were operated for CABG (21), AVR/MVR (14), CABG/VR (9) or aortic-dissection/tumor-exstirpation (3) (group I). 33 patients were classified as Child-Pugh (CP)-class A (subgroup A), 14 patients as CP-class B (subgroup B). Postoperative complications/mortality were analyzed retrospectively and compared to a propensity-score pair-matched control group of 47 patients (group II). Follow-up ranged from 0.1 to 11.5 years (mean 3.9±0.28years) and was complete for 100%.

Results: Necessity of blood products was higher in group I (red cells, fresh-frozen-plasma, platelets; p<0.01). Chest-tube-output (group I 1,113±857 vs. group II 849±521; p=0.15) and reexploration-rate (8.5% vs. 0%; p=0.11) were slightly accelerated. Ventilation time and ICU-stay was prolonged (p<0.015). Postcardiotomy-syndrome and pleurisy were more frequent in the cirrhosis-group (4/47 vs. 0/47p=0.11).

30-day-mortality revealed 19.1% (group I) versus 8.5% (group II); (p<0.01)), 6.1% (subgroup A) vs. 50% (subgroup B) (p<0.01). Operative risk in patients with CP-class B was 3,4fold higher than in CP-class A (p<0.03).

Actuarial survival after 3, 5 and 8 years was: group I 78.6%,75.6% and 70.2% versus group II 89.1%, 85.7% and 85.7% (p=0.08). Subgroup survival analysis was: group A 90.7/86.6 and 78.5% vs. group B 50%, 50% and 50% (p<0.01).

Conclusion: Cardiac surgery can be performed safely in patients with CP-class A and selected patients with CP-class B. Mid-term survival-rates within 8 years were not significantly different compared to a propensity pair-matched control group without cirrhosis.