Hepatic dysfunction following cardiac surgery: determinants and consequences

Abstract

Background/aims: We prospectively studied the determinants, characteristics, and consequences of hepatic dysfunction in the early postoperative period following cardiac surgery.

Methodology: We examined 3041 adult patients, mean age 60.6 (+/- 8.9), with normal pre-operative liver function who consecutively underwent open heart surgery in a newly established Cardiac Surgery Center. Patients were divided into two groups; Group A included all patients who developed hepatic dysfunction, defined as the presence of jaundice associated with an elevated serum bilirubin above 3 mg/dl, in the early postoperative period. The control group included cardiac surgical patients who did not develop such dysfunction.

Results: Hepatic dysfunction developed in 96 patients (3.2%). The affected patients consisted of 63 males and 33 females, mean age 60.8 (+/- 9.4). Determinants of hepatic dysfunction based on univariate analysis were sex, NYHA class, type of surgery, operative times, low cardiac output syndrome necessitating administration of inotropic agents and/or IABP usage, cardiac arrest, presence of hematomas, and number of blood transfusions. Patients with hepatic dysfunction required prolonged mechanical ventilation, stayed longer in the ICU (and in the hospital) and experienced a much higher mortality rate (11.4%) compared to the control group (p = 0.001).

Conclusion: Although the pathogenesis of hepatic dysfunction seems to be multifactorial, liver cell damage due to decreased perioperative hepatic flow and increased bilirubin load seem to be of critical importance. Early postoperative hepatic dysfunction resulted in increased morbidity and mortality.