Featured Research

from universities, journals, and other organizations

Cardiac Surgery In Patients With Liver Cirrhosis

Date:
July 6, 2007
Source:
John Wiley & Sons, Inc.
Summary:
A new study on the outcome of cardiac surgery in patients with liver cirrhosis found that the surgery can safely be performed in patients with milder disease, while those with more severe cirrhosis are less likely to survive.

A new study on the outcome of cardiac surgery in patients with liver cirrhosis found that the surgery can safely be performed in patients with milder disease, while those with more severe cirrhosis are less likely to survive.

Related Articles


The results of this study appear in the July 2007 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS), published on behalf of the societies by John Wiley & Sons, Inc.

In abdominal surgery, it is well known that the severity of liver cirrhosis, as measured by the Child-Pugh classification (a scoring system used to gauge the severity of liver disease) correlates directly with surgical outcome. However, few studies have reported how these patients fare when undergoing cardiac surgery.

Led by Farzan Filsoufi, of Mt. Sinai Hospital in New York, NY, researchers conducted a retrospective study of patients who underwent cardiac surgery at Mt. Sinai Medical Center between January 1998 and December 2004, and identified 27 patients who had cirrhosis. Of these, 18 patients had cardiac surgery with cardiopulmonary bypass (heart-lung machine) while the other 9 had surgery without using the heart-lung machine.

The results showed that hospital mortality increased significantly according to the Child-Pugh classification, with a mortality rate of 10 percent for those with class A, 18 percent for those with class B, and 67 percent for those with class C. Postoperative complications were also higher in class B and C than in class A. There was no correlation between mortality and the MELD (Model for End-Stage Liver Disease) score, however. Early studies reported a higher mortality for class B and C patients than seen in this study, but more recent studies have shown an improvement in survival rates. The current study confirms lower mortality for class B patients, which is probably due to improvements in surgical techniques and the management of cardiac surgery patients. In addition, there was no mortality for those who had coronary artery bypass surgery off-pump (without the heart-lung machine).

The authors note that alternative treatment strategies are needed for patients with advanced cirrhosis and cardiovascular diseases that require surgery. One potential approach is a combined liver transplant and cardiac operation, and there have been a few positive reports documenting such cases. "Despite early promising results with this combined approach the number of publications remains very limited and further investigations are required to determine the role of this treatment strategy in the armamentarium of cardiac and transplantation surgeons," the authors state. Although hospital mortality decreased in this study, the rates of postoperative complications in class B and C were 55 percent and 100 percent respectively. Surgical trauma and the deleterious effects of cardiopulmonary bypass may explain the increased rate of complications, according to the authors.

The authors conclude that "cardiac surgery can be performed with low operative mortality and good mid-term survival in patients with Child-Pugh class A." Acceptable results are also possible with class B patients, especially those who do not have surgery using the heart-lung machine, while for class C patients, who have cardiac surgery because of a life threatening condition, operative mortality remains high. The authors conclude: "Careful selection is critical in order to improve surgical outcome in patients with liver cirrhosis."

In an accompanying editorial in the same issue, Gonzalo Gonzalez-Stawinski, of Cleveland Clinic in Cleveland, OH, notes that cirrhotic patients requiring open heart surgery are among the most challenging and complex patients seen in cardiac surgery. The author notes that the current study raises the question of whether elective cardiac interventions should be offered to patients with advanced cirrhosis, in the hopes of improving their survival and quality of life. He states that "caution needs to be exercised when taking on cirrhotic patients as data provided by Filsoufi, et. al would suggest that most patients with either Childs-Pugh B or C do not gain a survival advantage by correcting their cardiac pathology." As an alternative, he suggests delaying and medically managing their heart disease in the hopes that they can undergo combined cardiac surgery and liver transplant, although not all patients would want or be eligible for such a solution and only a handful of centers in the U.S. have the capabilities to undertake it. He concludes, "Despite the challenges linked to the cirrhotic cardiac surgery patient, cardiac surgeons and hepatologists/liver transplant specialists need to continue to work in unison in hopes of improving the outcomes associated to this difficult patient population."

Articles:

"Early and Late Outcome of Cardiac Surgery in Patients With Liver Cirrhosis," Farzan Filsoufi, Sacha P. Salzberg, Parwis B. Rahmanian, Thomas D. Schiano, Hussien Elsiesy, Anthony Squire, David H. Adams, Liver Transplantation; July 2007; (DOI: 10.1002/lt.21075).

"Early and Late Outcomes of Cardiac Surgery in Patients With Liver Cirrhosis," Gonzalo Gonzalez-Stawinski, Liver Transplantation; July 2007; (DOI: 10.1002/lt.21112).


Story Source:

The above story is based on materials provided by John Wiley & Sons, Inc.. Note: Materials may be edited for content and length.


Cite This Page:

John Wiley & Sons, Inc.. "Cardiac Surgery In Patients With Liver Cirrhosis." ScienceDaily. ScienceDaily, 6 July 2007. <www.sciencedaily.com/releases/2007/07/070703171947.htm>.
John Wiley & Sons, Inc.. (2007, July 6). Cardiac Surgery In Patients With Liver Cirrhosis. ScienceDaily. Retrieved October 24, 2014 from www.sciencedaily.com/releases/2007/07/070703171947.htm
John Wiley & Sons, Inc.. "Cardiac Surgery In Patients With Liver Cirrhosis." ScienceDaily. www.sciencedaily.com/releases/2007/07/070703171947.htm (accessed October 24, 2014).

Share This



More Health & Medicine News

Friday, October 24, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

WHO: Millions of Ebola Vaccine Doses by 2015

WHO: Millions of Ebola Vaccine Doses by 2015

AP (Oct. 24, 2014) The World Health Organization said on Friday that millions of doses of two experimental Ebola vaccines could be ready for use in 2015 and five more experimental vaccines would start being tested in March. (Oct. 24) Video provided by AP
Powered by NewsLook.com
Doctor in NYC Quarantined With Ebola

Doctor in NYC Quarantined With Ebola

AP (Oct. 24, 2014) An emergency room doctor who recently returned to the city after treating Ebola patients in West Africa has tested positive for the virus. He's quarantined in a hospital. (Oct. 24) Video provided by AP
Powered by NewsLook.com
Breakfast Debate: To Eat Or Not To Eat?

Breakfast Debate: To Eat Or Not To Eat?

Newsy (Oct. 23, 2014) Conflicting studies published in the same week re-ignited the debate over whether we should be eating breakfast. Video provided by Newsy
Powered by NewsLook.com
Ebola Fears Keep Guinea Hospitals Empty

Ebola Fears Keep Guinea Hospitals Empty

AP (Oct. 23, 2014) Fears of Ebola are keeping doctors and patients alike away from hospitals in the West African nation of Guinea. (Oct. 23) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins