Cardiac surgery in patients with liver cirrhosis

Background. Cardiac surgery was infrequently performed in patients with liver cirrhosis, and its clinical outcome has been reported only in small series. We sought to evaluate the clinical outcome of cardiac operation in patients with noncardiac liver cirrhosis. Methods. Data were collected by a retrospective case note review. The preoperative, intraoperative, and postoperative variables were recorded. The severity of liver cirrhosis was graded using the Child-Pugh classification. Results. Between January 1993 and May 2004, 18 patients with liver cirrhosis underwent cardiac surgery at the authors' hospital. Thirteen patients had hepatitis virus infection, and 5 cases were alcohol related. Thirteen patients were classified as Child A cirrhosis, 4 were class B, and 1 was class C. Sixteen patients underwent cardiac surgery with the use of cardiopulmonary bypass, and 2 patients underwent off-pump coronary artery bypass surgery. The overall in-hospital mortality rate was 6% (1 of 18), and there was no death in 5 class B and C cirrhotic patients. The rate of major complication was 39% in class A and 80% in class B and C. Conclusions. Although the postoperative complication was common, cardiac operation could be performed safely in patients with mild and advanced liver cirrhosis. (c) 2005 by The Society of Thoracic Surgeons.