EurekaMag.com logo
+ 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


, : 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

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.

(PDF 0-2 workdays service)

Accession: 006345054

PMID: 6520446

Submit PDF Full Text: Here


Submit PDF Full Text

No spam - Every submission is manually reviewed

Due to poor quality, we do not accept files from Researchgate

Submitted PDF Full Texts will always be free for everyone
(We only charge for PDFs that we need to acquire)

Select a PDF file:
Close
Close

Related references

Sakagoshi N.; Kawazoe K.; Kitou Y.; Ohara K.; Kaku K.; Kosakai Y.; Fujii N.; Kasegawa H.; Kumon K.; E.A., 1987: The risk factors of high grade liver deterioration following open heart surgery in patients with preoperative liver dysfunction. Forty seven patients who had liver dysfunction with heart disease were reviewed to analyze pre- intra- and post-operative risk factors of high grade liver deterioration following open heart surgery. The patients were divided into two groups as fol...

Huber, T.; Grosse-Heitmeyer, W.; Rietbrock, S.; Harder, S., 1992: 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

An, Y.; Xiao, Y.B.; Zhong, Q.J., 2007: Open-heart surgery in patients with liver cirrhosis: indications, risk factors, and clinical outcomes. Background: Because of recent advances in cardiopulmonary bypass (CPB) surgery, there are broadened indications to approach patients with a high operative risk. Meanwhile, there is an increasing number of patients with severe liver dysfunction su...

Auricchio, A.; Stellbrink, C.; Block, M.; Sack, S.; Vogt, J.; Bakker, P.; Klein, H.; Kramer, A.; Ding, J.; Salo, R.; Tockman, B.; Pochet, T.; Spinelli, J., 1999: 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. Previous studies of pacing therapy for dilated congestive heart failure (CHF) have not established the relative importance of pacing site, AV delay, and patient heterogeneity on outcome. These variables were compared by a novel technique that eval...

Lin, L.Y.; Lin, J.L.e; Du, C.C.eng; Lai, L.P.ng; Tseng, Y.Z.; Huang, S.K.S.ephen, 2001: Reversal of deteriorated fractal behavior of heart rate variability by beta-blocker therapy in patients with advanced congestive heart failure. Introduction: The slope of the power spectrum in heart rate variability (HRV) reflects the fractal or scaling behavior in HR dynamics and recently was confirmed as an independent predictor of postmyocardial infarction survival. Whether or not the...

Manzione, N.C.; Goldfarb, J.P.; LeJemtel, T.H.; Maskin, C.S.; Sternlieb, I., 1986: The effects of two new inotropic agents on microsomal liver function in patients with congestive heart failure. The aminopyrine breath test (APBT) was used to study patients with chronic congestive heart failure before and after treatment with two chemically similar inotropic agents, amrinone (AR) and milrinone (MR), to determine their effects on hepatic mi...

Nanji, A.A.; Greenway, D.C., 1986: Widely differing plasma digoxin values in patients with congestive heart failure and severe liver dysfunction. A method-dependent problem. We studied plasma digoxin levels by three methods in patients with congestive heart failure who had no, mild to moderate, and severe liver dysfunction secondary to the heart failure. Our results indicate that in patients with severe liver dysfunct...

Edvinsson, M-Louise.; Uddman, E.; Andersson, S.E., 2012: Deteriorated function of cutaneous microcirculation in chronic congestive heart failure. Chronic congestive heart failure is a complex condition that leads to dysfunction in the peripheral microcirculation. We have previously shown that vascular reactivity is reduced with increasing age. In this study, we examined a group of very old...

Maeda, K.; Tsutamoto, T.; Wada, A.; Mabuchi, N.; Hayashi, M.; Tsutsui, T.; Ohnishi, M.; Sawaki, M.; Fujii, M.; Matsumoto, T.; Kinoshita, M., 2000: 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. OBJECTIVES: The aim of this study was to evaluate whether repetitive measurements of plasma levels of neurohumoral factors and cytokines before and after additional treatment are useful for predicting mortality in patients with congestive heart fa...

Køber, L.; Torp-Pedersen, C.; Pedersen, O.D.; Høiberg, S.; Camm, A.J., 1996: Importance of congestive heart failure and interaction of congestive heart failure and left ventricular systolic function on prognosis in patients with acute myocardial infarction. Left ventricular (LV) systolic function and congestive heart failure (CHF) are important predictors of long-term mortality after acute myocardial infarction. The importance of transient CHF and the interaction of CHF and LV function on prognosis h...