Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Ann Thorac Surg. 2012 Dec;94(6):1947-52. doi: 10.1016/j.athoracsur.2012.06.057. Epub 2012 Aug 24.
Empiric experiences suggest higher mortality and complication risk for patients with cirrhosis of the liver after cardiac surgery. However, cirrhosis is not considered a risk factor in either the EuroSCORE or The Society of Thoracic Surgeons score. We report a large single-center experience of patients with cirrhosis undergoing cardiac surgery with extracorporeal circulation and aimed to evaluate the severity of cirrhosis as a predictor of outcome.
During 2001 and 2011, we operated on 109 consecutive patients (average age, 64 years; 82 male) diagnosed for cirrhosis with cardiopulmonary bypass for different indications. Thirty-day mortality and long-term mortality were set as primary study end points.
Thirty-day mortality was 26%, and 5-year survival was 19%. Patients categorized as Child-Turcotte-Pugh (CHILD) C (n=6; 67% 30-day survival; 0% 5-year survival) and B (n=30; 60%; 5%) had worse 30-day and 5-year survival compared with patients categorized as CHILD A (n=73; 80%; 25%). For 30-day mortality, preoperative EuroSCORE (p=0.015), model for end-stage liver disease (MELD) score (p=0.006), albumin (p=0.023), total protein (p=0.01), and myocardial infarction (p=0.049) revealed significant differences between survivors and nonsurvivors. Multivariate logistic regression identified only MELD score (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.03 to 1.23; p=0.011) and total protein (OR, 0.97; 95% CI, 0.95 to 1; p=0.049) were connected with increased 30-day mortality. Cox regression analysis revealed EuroSCORE (OR, 1.02; 95% CI, 1.01 to 1.03; p<0.0001) and MELD (OR, 1.06; 95% CI, 1.01 to 1.12; p=0.016) predicting the overall mortality. Receiver operating characteristic analysis indicated significant predictive power of MELD (p=0.001) and EuroSCORE (p=0.027) for 30-day mortality.
Patients with cirrhosis undergoing heart surgery with extracorporeal circulation have a poor prognosis. Several preoperative factors are related to outcome. EuroSCORE and MELD score may help to evaluate operation risk and indication.
经验表明，心脏手术后患有肝硬化的患者死亡率和并发症风险更高。然而，在 EuroSCORE 或胸外科医师协会评分中，肝硬化并不被视为危险因素。我们报告了一个大型单中心的肝硬化患者接受体外循环心脏手术的经验，并旨在评估肝硬化的严重程度作为预后的预测因子。
在 2001 年至 2011 年间，我们对 109 例连续诊断为肝硬化并接受体外循环治疗的患者进行了手术，这些患者的平均年龄为 64 岁，82 例为男性，手术指征各不相同。30 天死亡率和长期死亡率被设定为主要研究终点。
30 天死亡率为 26%，5 年生存率为 19%。被归类为 Child-Turcotte-Pugh (CHILD) C 级（n=6；30 天生存率 67%；5 年生存率 0%）和 B 级（n=30；60%；5%）的患者与被归类为 CHILD A 级（n=73；80%；25%）的患者相比，30 天和 5 年生存率更差。对于 30 天死亡率，术前 EuroSCORE（p=0.015）、终末期肝病模型（MELD）评分（p=0.006）、白蛋白（p=0.023）、总蛋白（p=0.01）和心肌梗死（p=0.049）在幸存者和非幸存者之间存在显著差异。多变量逻辑回归仅确定 MELD 评分（优势比[OR]，1.12；95%置信区间[CI]，1.03 至 1.23；p=0.011）和总蛋白（OR，0.97；95%CI，0.95 至 1；p=0.049）与增加 30 天死亡率有关。Cox 回归分析显示，EuroSCORE（OR，1.02；95%CI，1.01 至 1.03；p<0.0001）和 MELD（OR，1.06；95%CI，1.01 至 1.12；p=0.016）预测总体死亡率。受试者工作特征分析表明，MELD（p=0.001）和 EuroSCORE（p=0.027）对 30 天死亡率具有显著的预测能力。
接受体外循环心脏手术的肝硬化患者预后不良。几个术前因素与预后有关。EuroSCORE 和 MELD 评分可帮助评估手术风险和适应证。
