The risk factors of high grade liver deterioration following open heart surgery--in patients with preoperative liver dysfunction
Sakagoshi, N.; Kawazoe, K.; Kitou, Y.; Ohara, K.; Kaku, K.; Kosakai, Y.; Fujii, N.; Kasegawa, H.; Kumon, K.; Fukita, T.
Nihon Kyobu Geka Gakkai 35(1): 42-48
1987
ISSN/ISBN: 0369-4739 PMID: 3572122 Document Number: 294037
Forty seven patients who had liver dysfunction with heart disease were reviewed to analyze pre- intra- and post-operative risk factors of high grade liver deterioration following open heart surgery. The patients were divided into two groups as follows for this analysis. Group A: patients with a postoperative total bilirubin (T. Bil.)level of 4.0 mg/dl or more (deterioration group). Group B: patients with a postoperative T. Bil. level of less than 4.0 mg/dl (non-deterioration group). Preoperative liver function, total amount of transfused blood, extracorporeal circulation time and postoperative complications were compared between two groups. The results were as follows. 1. Patients, either with preoperative T. Bil .gtoreq. 3.0 mg/dl or with both preoperative T. Bil .gtoreq. 2 mg/dl and P. T. .ltoreq. 49%, tended to develop high grade liver deterioration, postoperatively (P < 0.01). These preoperative liver dysfunctions described above were thought to be preoperative risk factors. 2. Patients, either with total amount of transfused blood .gtoreq. 4000 ml or with extracorporeal circulation (ECC) time .gtoreq. 120 min tended to develop liver deterioration (p < 0.05). These criteria were thought to be intraoperative risk factors. 3. Patients with postoperative complications such as low output syndrome (LOS), high CVP (mean CVP .gtoreq. 13 cmH2O), reoperation and sepsis, also tended to develop liver deterioration (p < 0.01). These postoperative complications were thought to be postoperative risk factors. 4. In some patients included in group A, there liver functions were made much worse by these complications described above. These complications were thought to be aggravating factors of liver deterioration. 5. In group A, two patients died of sepsis and one died of hepatic failure. Other patients survived. One of them recovered from severe liver dysfunction by appropriate plasma-exchange. There are some risk factors, which could be overcome by improvement of operative technique and/or postoperative care. Postoperative high grade liver deterioration could be to some extent prevented by means of control of these risk factors.