EurekaMag.com logo
+ Site Statistics
References:
52,725,316
Abstracts:
28,411,598
+ Search Articles
+ Subscribe to Site Feeds
EurekaMag Most Shared ContentMost Shared
EurekaMag PDF Full Text ContentPDF Full Text
+ PDF Full Text
Request PDF Full TextRequest PDF Full Text
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter
Follow on Google+Follow on Google+
Follow on LinkedInFollow on LinkedIn

+ Translate

Risk factors and management of deteriorated liver function following open heart surgery in patients with pre existing congestive liver dysfunction due to heart failure


Journal of the Japanese Association for Thoracic Surgery 32(10): 1762-1774
Risk factors and management of deteriorated liver function following open heart surgery in patients with pre existing congestive liver dysfunction due to heart failure
Patients who had associated liver dysfunction with heart failure were evaluated in order to discover pre and perioperative risk factors of liver deterioration following open-heart surgery. The management of postoperative hepatic failure is also discussed. The results were as follows. There was a significant correlation between both preoperative hepaplastintest (Hpt) and maximal removal rate of ICG [indocyanin green] (ICG Rmax) and the postoperative level of serum total bilirubin (r = -0.55, P < 0.05; r = -0.41, P < 0.05). In patients in diabetic and borderline groups (differentiated by the glucose tolerance test (50 g GTT)) the lowest value of choline esterase (ChE) in the postoperative period was significantly lower than in normal patients (P < 0.05). There was a significant correlation between the total amount of blood transfused and the postoperative levels of peak total bilirubin and peak LDH [lactate dehydrogenase] (r = 0.40, P < 0.01; r = 0.46; P < 0.01). There was a significant correlation between the CPB time and postoperative levels of peak total bilirubin, peak GOT [glutamic oxaloacetic transaminase] and peak LDH (r = 0.68, P < 0.01; r = 0.53, P < 0.01; r = 0.64, P < 0.01). There was a significant correlation between .**GRAPHIC**. mm Hg .cntdot. L/min .cntdot. M2 in the early postoperative period and postoperative levels of peak total bilirubin and peak LDH (r = -0.53, P < 0.01; r = -0.43, P < 0.05). Postoperative levels of total bilirubin and GPT [glutamic pyruvate dehydrogenase] divided the patients into 2 groups: Group A: patients with a total bilirubin level of 5.0 mg/dl or more and/or GPT level of 100 units or more, Group B: patients with a total bilirubin level of less than 5.0 mg/dl and a GPT level of less than 100 units. There was a significant difference in .**GRAPHIC**. between group A and B in the early postoperative period (P < 0.05), although no significant difference between these 2 groups was found in preoperative hepatic functional reserve as evaluated by Hpt, ICG Rmax and 50 g GTT. From these results it was concluded that most patients with preexisting congestive liver dysfunction have a functional reserve sufficient to survive open-heart surgery. The most important way to prevent the deterioration of preexisting liver dysfunction following open-heart surgery is to avoid severe low cardiac output which produces hepatic anoxia. Plasmapheresis can be an effective therapy for acute hepatic failure following open-heart surgery.


Accession: 006345054

PMID: 6520446



Related references

The risk factors of high grade liver deterioration following open heart surgery in patients with preoperative liver dysfunction. Journal of the Japanese Association for Thoracic Surgery 35(1): 42-48, 1987

Pharmacokinetics and pharmacodynamics of molsidomine in patients with liver dysfunction due to congestive heart failure. International Journal of Clinical Pharmacology, Therapy, and Toxicology 30(11): 491-492, 1992

Open-heart surgery in patients with liver cirrhosis: indications, risk factors, and clinical outcomes. European Surgical Research. Europaische Chirurgische Forschung. Recherches Chirurgicales Europeennes 39(2): 67-74, 2007

Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. The Pacing Therapies for Congestive Heart Failure Study Group. The Guidant Congestive Heart Failure Research Group. Circulation 99(23): 2993-3001, 1999

Reversal of deteriorated fractal behavior of heart rate variability by beta-blocker therapy in patients with advanced congestive heart failure. Journal of Cardiovascular Electrophysiology 12(1): 26-32, January, 2001

The effects of two new inotropic agents on microsomal liver function in patients with congestive heart failure. American Journal of the Medical Sciences 291(2): 88-92, 1986

Widely differing plasma digoxin values in patients with congestive heart failure and severe liver dysfunction. A method-dependent problem. Archives of Pathology & Laboratory Medicine 110(1): 75-76, 1986

Deteriorated function of cutaneous microcirculation in chronic congestive heart failure. Journal of Geriatric Cardiology 8(2): 82-87, 2012

High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure. Journal of the American College of Cardiology 36(5): 1587-1593, November 1, 2000

Importance of congestive heart failure and interaction of congestive heart failure and left ventricular systolic function on prognosis in patients with acute myocardial infarction. American Journal of Cardiology 78(10): 1124-1128, 1996