Prediction of postoperative hepatic dysfunction after cardiac surgery in patients with chronic congestive heart failure

Abstract

Objective

Chronic congestive liver dysfunction in advanced valvular disease remains an important co-morbidity in open heart surgery. The objective of this study was to explore the prognostic value in patients with severe valvular disease associated with congestive liver dysfunction.

Methods

From 1997 to 2004, a total of 63 patients who had valvular disease with moderate or severe tricuspid regurgitation were studied. In addition to the indocyanine green retention rate at 15 min (ICG15) and the Child-Pugh score, we measured serum total bilirubin (T-bil), asparate aminotransferase (AST), alanine aminotransferase (ALT), cholinesterase (ChE), albumin (Alb) concentration, and prothrombin time. We compared these preoperative factors with postoperative liver dysfunction and mortality and attempted to develop a new liver function score.

Results

There were eight in-hospital deaths (13%). Seventeen patients had postoperative liver dysfunction. The univariate analysis indicated there were significant differences in preoperative T-bil, Alb, ChE, ICG15, and Child-Pugh score between the patients with and without liver dysfunction. Multivariate logistic regression analysis also identified preoperative T-bil as a significant indicator of postoperative liver dysfunction and preoperative ChE as a predictor of mortality. Based on these findings, we introduced a liver function score to predict postoperative dysfunction and death.

Conclusion

In addition to preoperative ChE, T-bil and Alb appeared to be valuable for producing obtainable prognostic information regarding postoperative liver dysfunction in patients with severe valvular disease. A new liver score, including T-bil, ChE, and Alb, is proposed for predicting postoperative hepatic dysfunction and outcome.