CARDIAC OPERATIONS IN PATIENTS WITH CIRRHOSIS

Background. A retrospective review was performed to determine the outc ome after cardiac operations in patients with a documented history of noncardiac cirrhosis. Methods. The charts of patients admitted to the cardiothoracic surgical service between 1990 and 1996 were reviewed, a nd 13 patients with a preoperative history of cirrhosis were identifie d. The severity of preoperative liver disease was graded according to the criteria of Child. Results. Most of the cases of cirrhosis were al cohol-related. Eight patients were classified as having Child class A and 5 as having Child class B cirrhosis. One hundred percent of patien ts with Child class B and 25% of those with Child class A cirrhosis ha d major complications. The postoperative chest tube output and transfu sion requirements of these patients were approximately three times hig her than average. The overall perioperative mortality rate was 31%. In patients with Child class B cirrhosis, the mortality rate was 80%. No patient with Child class A cirrhosis died. Deaths were related to gas trointestinal and septic complications, and not to cardiovascular fail ure. Conclusions. These findings suggest that patients with minimal cl inical evidence of cirrhosis can tolerate cardiopulmonary bypass and c ardiac surgical procedures, whereas those with more advanced liver dis ease should not be offered operation. (C) 1998 by The Society of Thora cic Surgeons.