A clinical study on the mechamism and early diagnosis of acute liver dysfunction following cardiac surgery.

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Acute liver dysfunction (ALD) is one of the major complications after cardiac surgery. To elucidate the mechanism of ALD following cardiac surgery and to establish useful predictor for ALD, we introduced hepatic venous oxygen saturation (ShvO_2) monitoring to the patients who underwent cardiac surgery.In 37 patients: 17 with congenital and 20 with acquired heart disease, ShvO_2 was measured for 1-4 days postoperatively. The mean ShvO_2 value for 24 hours around the lowest point (m-ShvO_2) was compared with the postoperative results of liver functions, hepatic lactate metabolism and hemodynamics. The results were as follows:1. m-ShvO_2 ranged from 5% to 79% with the average of 44%.2. In 14 patients with m-ShvO_2 <30%, 11 patients developed ALD with serum alanine aminotransferase (ALT) >100 U/l (the highest value: 4,050 U/l) or serum total bilirubin (TB)>3.0mg/dl (the highest: 11.5 mg/dl), and there were significant inverse correlations between m-ShvO_2 and the highest value of blood chemistry (ALT, GLDH, T-Bil). In 23 patients with m-ShvO_2>40%, the liver function indices stayed within almost normal ranges without significant correlations to m-ShvO_2.3. In 14 patients with m-ShvO_2 <30%, there was a significant inverse correlation between m-ShvO_2 and hepatic venous lactate pyruvate ratio.4. m-ShvO_2 showed significant relation to mixed venous oxygen saturation (SvO_2) and CVP in multivariate analysis.5. In pre, peri and postoperative factors, m-ShvO_2 most significantly contributed to ALD-score in multivariate analysis.In conclusion, significant decrease in ShvO_2 as below 30% appears to indicate hepatic tissue hypoxia causing ALD from hepatic hypoperfusion with resultant from systemic hypoperfusion and high CVP. And ShvO_2 monitoring may be useful to predict the development of ALD in critical patients after cardiac surgery.