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Open-heart surgery in patients with cirrhosis: Variables associated with survival outcomes

Calvelli, Hannah
; 
Kashem, Mohammed Abul
; 
Hanna, Katherine
; 
Zhao, Huaqing
; 
Raman, Ravishankar
; 
Toyoda, Yoshiya
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Journal article
Date
2024-01-26
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Temple University. Hospital
Center for Biostatistics and Epidemiology (Temple University)
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Subject
Open-heart
 Cirrhosis
 Survival
 Outcomes
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https://scholarshare.temple.edu/handle/20.500.12613/11622
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CalvelliEtAl-JournalArticle-2024-01.pdf
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https://doi.org/10.1016/j.sycrs.2024.100006
Abstract
Background Understanding the risks of performing open-heart surgery in patients with cirrhosis is of critical importance given increased risks of morbidity and mortality. We analyzed the variables and risk scoring systems associated with survival and postoperative outcomes among patients with cirrhosis after open-heart surgery. Methods This is a single-center retrospective study of 32 patients with cirrhosis who underwent open-heart surgery at our institution between August 2020 – September 2022. Patients were stratified by mortality status to compare demographic and clinical variables. Survival was assessed using Kaplan-Meier curves and log-rank tests for the following variables: Model for End-Stage Liver Disease (MELD) score (<11 vs ≥11), Child-Turcotte-Pugh (CTP) class (A vs B vs C), Society of Thoracic Surgeons (STS) score (predicted mortality <4 vs 4 to 8 vs ≥8), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (<3.3 vs ≥3.3), and cardiopulmonary bypass (off pump vs on pump). Results Overall survival for our patient cohort was 93.8% at 30 days, 81.3% at 1 year, and 78.1% at 2 years postoperatively. Increased preoperative creatinine (p = 0.049), preoperative total bilirubin (p = 0.017), intraoperative blood products (p = 0.016), and intensive care unit length of stay (p = 0.001) were significantly associated with decreased survival. Among the risk scoring systems, only CTP class was significantly associated with survival (p < 0.0001). Conclusions We demonstrated high short-term and long-term survival among patients with cirrhosis after open-heart surgery, suggesting that select patients may be operative candidates. Among risk-scoring systems, only CTP was significantly associated with survival, which may guide future risk stratification strategies.
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Hannah Calvelli, Mohammed Abul Kashem, Katherine Hanna, Huaqing Zhao, Ravishankar Raman, Yoshiya Toyoda, Open-heart surgery in patients with cirrhosis: Variables associated with survival outcomes, Surgery Case Reports, Volume 1, 2024, 100006, ISSN 2950-1032, https://doi.org/10.1016/j.sycrs.2024.100006. (https://www.sciencedirect.com/science/article/pii/S2950103224000069)
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Elsevier
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Surgery Case Reports, Vol. 1
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