Clinical outcome after cardiac operations in patients with cirrhosis
Clinical outcome after cardiac operations in patients with cirrhosis
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DOI：
10.1016/j.athoracsur.2003.06.021
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发表时间：
2004-02-01
影响因子：
4.6
通讯作者：
Aoyagi, S
中科院分区：
文献类型：
--
作者：
Hayashida, N;Shoujima, T;Aoyagi, S
背景为评价肝硬化患者心脏手术后的临床结局，进行了一项回顾性研究。1989年至2003年，18例肝硬化谁接受心脏手术被确定。评估术前状态和术后临床结果。10例患者被分类为Child-Pugh A级肝硬化，7例为B级肝硬化，1例为C级肝硬化。18例患者中15例采用体外循环进行心脏手术，其余3例B级肝硬化患者在非体外循环下接受冠状动脉旁路移植术。在接受体外循环的患者中，60%的A级肝硬化患者和100%的B级肝硬化和C级肝硬化患者发生术后主要并发症，包括感染、呼吸衰竭、肾衰竭、出血和胃肠道疾病。3例B级肝硬化患者中有1例（33%）在非体外循环下接受冠状动脉旁路移植术，发生严重并发症。术后总死亡率为17%。A级肝硬化、B级肝硬化和C级肝硬化患者接受体外循环的住院死亡率分别为0%、50%和100%。本研究中，3例非体外循环冠状动脉旁路移植术的B级肝硬化患者均无死亡。结论。虽然主要并发症的发生率很高，但Child-Pugh A级肝硬化患者对心脏手术的耐受性令人满意。然而，更晚期的肝硬化患者可能不适合进行心肺转流的择期心脏手术。虽然我们的结果还不是决定性的，但对于需要手术血运重建的晚期肝硬化患者，无心肺转流的冠状动脉旁路移植术可以是一种替代治疗策略。(C)2004年由胸外科医师协会发布。
Background. To evaluate the clinical outcome after cardiac operations in patients with cirrhosis, a retrospective study was undertaken.Methods. Between 1989 and 2003, 18 patients with cirrhosis who underwent cardiac operations were identified. Their preoperative status and postoperative clinical results were assessed.Results. Ten patients were classified as having Child-Pugh class A cirrhosis, 7 as having class B cirrhosis, and 1 as having class C cirrhosis. Fifteen of 18 patients underwent cardiac surgery using cardiopulmonary bypass, and the remaining 3 patients with class B cirrhosis received coronary artery bypass grafting without cardiopulmonary bypass. In patients undergoing cardiopulmonary bypass, 60% of those with class A cirrhosis and 100% of those with class B cirrhosis and class C cirrhosis had postoperative major complications, including infection, respiratory failure, renal failure, bleeding, and gastrointestinal disorder. One of 3 patients (33%) with class B cirrhosis undergoing coronary artery bypass grafting without cardiopulmonary bypass had major complications. The overall postoperative mortality rate was 17%. Hospital mortality of patients with class A cirrhosis, class B cirrhosis, and class C cirrhosis undergoing cardiopulmonary bypass was 0%, 50%, and 100%, respectively. None of 3 patients with class B cirrhosis undergoing coronary artery bypass grafting without cardiopulmonary bypass died in this study.Conclusions. Although the incidence of major complications was high, patients with Child-Pugh class A cirrhosis tolerated cardiac surgery satisfactorily. Patients with more advanced cirrhosis, however, may not be suitable for elective cardiac operations with cardiopulmonary bypass. Although our results are not conclusive, coronary artery bypass grafting without cardiopulmonary bypass can be an alternative therapeutic strategy for patients with advanced cirrhosis requiring surgical revascularization. (C) 2004 by The Society of Thoracic Surgeons.