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Year : 2017  |  Volume : 4  |  Issue : 4  |  Page : 213-225

Risk factors in adult patients with chronic hepatitis C virus undergoing cardiac surgery with cardiopulmonary bypass: a prospective study

Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

Correspondence Address:
Ayman F Khalifa
Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/roaic.roaic_61_16

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Background Variable outcomes of cardiac operations have been reported in patients with liver disease, but no definitive predictive prognostic factors have been established. This prospective study assessed operative results to identify risk factors associated with morbidity after cardiovascular operations in patients with chronic viral hepatitis. Patients and methods The study group consisted of 90 patients with documented chronic viral hepatitis who were subject to elective cardiac surgery with cardiopulmonary bypass (CPB). Potential preoperative predictors of outcome, as well as preoperative model for end-stage liver disease (MELD) score and European system for cardiac operative risk evaluation (EuroSCORE), were calculated. The primary study end points were hospital morbidity (according to sequential organ failure assessment score and other additional morbidities not captured by sequential organ failure assessment score) or mortality (as defined by EuroSCORE II). Results The average EuroSCORE II was 1.12±0.56. The average MELD score was 10.12±2.7, which corresponds to a mild to moderate liver dysfunction. Despite the low EuroSCORE II values, 39 patients developed postoperative significant morbidity including seven patients who died in hospital. There were four patients with gastrointestinal complications (two cases with prolonged ileus and two cases with gastrointestinal bleeding bleeding); eight cases with occurrence of infection (six cases with sternal wound infection and two cases with sepsis); five reopen cases; and five cases that needed intra-aortic balloon pump. Analysis showed significant differences in age, MELD score, preoperative platelet count, preoperative creatinine, and preoperative total bilirubin when patients with postoperative morbidity and mortality (group M) were compared with patients without significant morbidity (group N). CPB time, cross-clamp time, postoperative mechanical ventilation, and duration of ICU stay were significantly higher in the group M. In addition, blood products transfused and total chest tubes drainage were significantly higher in the group M. Central venous pressure was significantly higher in the group M after weaning of CPB and thereafter. Arrhythmias were seen postoperatively in 16.6% of cases, the most common being atrial fibrillation, and was significantly higher in the group M. Receiver operating characteristic curve analysis showed that age of 58 years and MELD score of 12 were cutoff values for hospital morbidity, whereas the optimal cutoff values for preoperative platelet count, creatinine, and total bilirubin were 146×103/μl, 1.27 mg/dl, and 1.21 mg/dl, respectively. Conclusion Careful consideration of operative indications and methods are necessary in chronic viral hepatitis patients with old age, high MELD scores, low platelet counts, and high serum creatinine and bilirubin. It is vital that liver dysfunction is added to the risk models, which are currently used to predict the postoperative morbidity of cardiac surgery patients.

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