• Heng-Wen Chou, Ming-Hsien Lin, Yih-Sharng Chen, and Hsi-Yu Yu.
• Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan university, Taiwan.
• J Formos Med Assoc. 2020 Apr 1; 119 (4): 838-844.

BackgroundThe outcome of open-heart surgery for patients with liver cirrhosis (LC) varies widely, indicating multifactorial influences on liver injury after cardiopulmonary bypass (CPB).MethodsThis observational single center study evaluated adult LC patients receiving open heart surgery with CPB during 2007 and 2017. The primary endpoint was post-operative hypoxic hepatitis (POHH), defined by post-operative serum glutamate oxaloacetate transaminase and glutamate pyruvate transaminase more than 10 times the pre-operative value.ResultsIn total, 61 patients were included in the study, of whom 14 (18.7%) developed POHH. Hospital mortality of non-POHH group (4.3%) was similar to that estimated using Euroscore II (4.0%), but that of the POHH group (21.4%) was 2.7 times as that estimated using Euroscore II (8.0%). Model for End-Stage Liver Disease (MELD) score and CPB duration were found as independent risk factors for POHH by multivariate logistic regression. POHH incidence was 0.0% if MELD <5 and 80.0% of MELD >20 regardless of CPB duration. For those with MELD between 5 and 20, POHH incidence increases as CPB duration increases.ConclusionFor LC patients undergoing cardiac surgery with CPB, the incidence of POHH is highly associated with MELD score and CPB duration. To prevent POHH, the CPB duration should be shortened for those with MELD score between 5 and 20, and CPB be avoid for those with MELD >20.Copyright © 2019. Published by Elsevier B.V.

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