Department of Cardiothoracic Surgery and Transplantation, University Hospital of Nancy-Brabois, Vandoeuvre lès Nancy, France.
Eur J Cardiothorac Surg. 2012 Aug;42(2):293-9. doi: 10.1093/ejcts/ezr320. Epub 2012 Jan 26.
Liver cirrhosis increases mortality and morbidity following cardiac surgery. This study evaluated the results of cardiac surgery in cirrhotic patients and the relevance of EuroSCORE, Child-Turcotte-Pugh (CTP) class and model for end-stage liver disease (MELD) score in terms of prediction of surgical mortality and survival.
The study involved 34 patients with hepatic cirrhosis who underwent cardiac surgery between January 1996 and January 2010.
The in-hospital mortality was 26%. Postoperative mortality of patients with CTP class A, B or C was 18, 40 and 100%, respectively. In univariate analysis, a history of cerebrovascular disease and hypoalbuminaemia was predictive of operative mortality. Multivariate exact logistic regression revealed that hypoalbuminaemia was an independent factor. Long-term survival was 63 ± 0.08% at 1 year and 40.2 ± 0.12% at 5 years. The 1-year survival for CTP A, B and C was 76.7 ± 0.09, 60 ± 15.4 and 0%, respectively, and the 5-year survival was 60 ± 15.4, 25 ± 0.19 and 0%, respectively. The EuroSCORE was not a discriminant [area under the curve (AUC): 0.57 ± 0.15]. The performance of CTP class and MELD score was better, but neither provided optimal discrimination: AUC was 0.691 ± 0.110 for MELD and 0.658 ± 0.10 for CTP class.
Cardiac surgery can be performed safely in CTP class A patients. In CTP C patients, surgery is hazardous, and an alternative treatment must be considered. In CTP B, the MELD score could be helpful in deciding whether surgical intervention is a reasonable option.
肝硬化会增加心脏手术后的死亡率和发病率。本研究评估了肝硬化患者接受心脏手术后的结果，以及欧洲心脏手术风险评分（EuroSCORE）、Child-Turcotte-Pugh（CTP）分级和终末期肝病模型（MELD）评分在预测手术死亡率和生存率方面的相关性。
本研究纳入了 1996 年 1 月至 2010 年 1 月期间接受心脏手术的 34 例肝硬化患者。
院内死亡率为 26%。CTP 分级为 A、B 或 C 的患者术后死亡率分别为 18%、40%和 100%。单因素分析显示，脑血管病史和低白蛋白血症是手术死亡率的预测因素。多因素精确逻辑回归显示，低白蛋白血症是独立的危险因素。长期生存率为术后 1 年 63 ± 0.08%，5 年 40.2 ± 0.12%。CTP A、B 和 C 分级的 1 年生存率分别为 76.7 ± 0.09%、60 ± 15.4%和 0%，5 年生存率分别为 60 ± 15.4%、25 ± 0.19%和 0%。EuroSCORE 不是一个有区别的指标[曲线下面积（AUC）：0.57 ± 0.15]。CTP 分级和 MELD 评分的性能更好，但都没有提供最佳的区分度：MELD 的 AUC 为 0.691 ± 0.110，CTP 分级的 AUC 为 0.658 ± 0.10。
CTP 分级 A 级的患者可以安全地进行心脏手术。CTP 分级 C 级的患者手术风险较高，必须考虑替代治疗方法。在 CTP 分级 B 级中，MELD 评分有助于确定手术干预是否是合理的选择。
