Early and late outcome after elective cardiac surgery in patients with cirrhosis

Background. A prospective study was performed to evaluate the early and lat e outcome after elective cardiac surgery in patients with cirrhosis. Methods. All patients who underwent elective cardiac surgery between 1995 a nd 1997, and were suspected of having a history of cirrhosis, were followed in the intensive care unit (ICU), during hospitalization and after hospita l discharge. All patients received high doses of aprotinin during surgery. Results. Ten patients of Child-Pugh class A and 2 patients of Child-Pugh cl ass B were studied. All patients had signs of portal hypertension, and 11 o f 12 patients had thrombocytopenia. In the first 24 h after operation, the median chest tube output was 810 mL (range 350 to 1,500 mL). Median ICU and hospital stays were 3 and 15 days, respectively (range 2 to 10 and 7 to 36 days, respectively). Seven patients experienced postoperative morbidity an d 7 patients had significant complications after their hospital discharge. One death occurred in the ICU. Two deaths occurred after hospital discharge and were related to further hepatic damage. Conclusions. These results suggest that, in patients with mild or moderate cirrhosis, the incidence of significant complications was high after electi ve cardiac surgery, increasing the length of stay in ICU and overall hospit alization time and compromising the health status, even well after the oper ation. (Ann Thorac Surg 1999;67:1334-8) (C) 1999 by The Society of Thoracic Surgeons.