Clinical Results of Cardiac Surgery in Patients with Chronic Hepatitis C and Their Role in Risk Models: A Case-Control Study
21 September 2016
10 January 2017
10 March 2017 (eFirst)
Background To evaluate the results of patients with chronic hepatitis C virus (HCV) following cardiac surgery in the TurcoSCORE (TrS) database.
Methods Sixty patients with HCV who underwent cardiac surgery between 2005 and 2016 in our clinic out of a total 8,018 patients from the TrS database were included in the study. The perioperative morbidity and mortality rates in these patients were compared with a matched cohort.
Results The mean follow-up time was 96.6 ± 12.3 months. Hospital mortality rates (HCV group 5% vs. control group 1.7%, p = 0.61) were similar between the groups. No significant difference was found in the duration of cardiopulmonary bypass (HCV 79.1 ± 12.3 vs. control 82.6 ± 11.8, p = 0.88) and cross clamps (HCV 33.4 ± 6.9 vs control 33.8 ± 7.2 p = 0.76) between the two groups. The rate of patients who were revised due to postoperative hemorrhage was significantly higher in the HCV arm compared with the matched cohort (HCV 13.3% vs. control 1.7%, p < 0.05). Although the measured prothrombin time (PT) and international normalized ratio (INR) in the postoperative 24th hour were in normal ranges in both arms, they were significantly higher in the HCV arm (HCV 11.2 ± 1.2 vs. control 10.5 ± 0.8, p < 0.05; HCV 0.99 ± 0.06, vs. control 0.92 ± 0.03, p < 0.0001).
Conclusion The presence of HCV can be an important prognostic factor for morbidity in patients undergoing cardiac surgery. It can also play an important role in the risk models generated for cardiac surgery.
- 1 Tozun N, Ozdogan OC, Idilman R, Karasu Z, Akarca US , et al. A Nationwide prevalence study and risk factors for Hepatitis A, B, C and D infections in Turkey. The 61st Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting® 2010. October 29 November 2 2010, Boston, Massachusetts, USA, Hepatology 2010; 52 (Suppl S1): 697A
- 2 European Centre for Disease Prevention and Control. Hepatitis B and C in the EU neighbourhood: prevalence, burden of disease and screening policies. Stockholm: ECDC; 2010
- 3 National Health and Nutrition Examination Survey Data. 2009–2010 Centers for Disease Control and Prevention. National Center for Health Statistics. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2012
- 4 Davis GL, Alter MJ, El-Serag H, Poynard T, Jennings LW. Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression. Gastroenterology 2010; 138 (2) 513-521 , 521.e1–521.e6
- 5 Vassalle C, Masini S, Bianchi F, Zucchelli GC. Evidence for association between hepatitis C virus seropositivity and coronary artery disease. Heart 2004; 90 (5) 565-566
- 6 Satapathy SK, Kim YJ, Kataria A , et al. Higher Prevalence and More Severe Coronary Artery Disease in Hepatitis C Virus-Infected Patients: a case control study. J Clin Exp Hepatol 2013; 3 (3) 186-191
- 7 Butt AA, Xiaoqiang W, Budoff M, Leaf D, Kuller LH, Justice AC. Hepatitis C virus infection and the risk of coronary disease. Clin Infect Dis 2009; 49 (2) 225-232
- 8 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
- 9 Emerson D, Endicott K, Amdur R, Trachiotis G. Cardiac surgery in patients chronically infected with hepatitis C virus: long-term outcomes and comparison to historical controls and human immunodeficiency virus infection. J Cardiovasc Surg (Torino) 2016; 57 (4) 598-605
- 10 Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16 (1) 9-13
- 11 Roques F, Nashef SA, Michel P , et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 1999; 15 (6) 816-822 , discussion 822–823
- 12 Sergeant P, Meuris B, Pettinari M. EuroSCORE II, illum qui est gravitates magni observe. Eur J Cardiothorac Surg 2012; 41 (4) 729-731
- 13 Nashef SA, Roques F, Sharples LD , et al. EuroSCORE II. Eur J Cardiothorac Surg 2012; 41 (4) 734-744 , discussion 744–745
- 14 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
- 15 O'Brien SM, Shahian DM, Filardo G , et al; Society of Thoracic Surgeons Quality Measurement Task Force. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery. Ann Thorac Surg 2009; 88 (1, Suppl): S23-S42
- 16 Akar AR, Kurtcephe M, Sener E , et al; Group for the Turkish Society of Cardiovascular Surgery and Turkish Ministry of Health. Validation of the EuroSCORE risk models in Turkish adult cardiac surgical population. Eur J Cardiothorac Surg 2011; 40 (3) 730-735
- 17 Kunt AG, Kurtcephe M, Hidiroglu M , et al. Comparison of original EuroSCORE, EuroSCORE II and STS risk models in a Turkish cardiac surgical cohort. Interact Cardiovasc Thorac Surg 2013; 16 (5) 625-629
- 18 Pothineni NV, Delongchamp R, Vallurupalli S , et al. Impact of hepatitis C seropositivity on the risk of coronary heart disease events. Am J Cardiol 2014; 114 (12) 1841-1845
- 19 Barone M, Viggiani MT, Amoruso A , et al. Endothelial dysfunction correlates with liver fibrosis in chronic HCV infection. Gastroenterol Res Pract 2015; 2015: 682174
- 20 Friedman LS. The risk of surgery in patients with liver disease. Hepatology 1999; 29 (6) 1617-1623
- 21 Morimoto N, Okada K, Okita Y. The model for end-stage liver disease (MELD) predicts early and late outcomes of cardiovascular operations in patients with liver cirrhosis. Ann Thorac Surg 2013; 96 (5) 1672-1678
- 22 Gansera LS, Eszlari E, Deutsch O, Eichinger WB, Gansera B. High-Risk Cardiac Surgery in Patients with Intravenous Drug Abuse and/or Active Hepatitis C or HIV Infection: an ethical discussion of six cases. Thorac Cardiovasc Surg 2016; 64 (1) 2-5