Objective:

Our goal was to determine the risk factors associated with morbidity and mortality related to the development of hepatic dysfunction in the postoperative period of open-heart surgeries.

Methods:

In a prospective study, 92 consecutive patients were divided into three groups depending on the operation type as; Group 1 (n=36); coronary artery bypass graft surgery (CABG), Group 2 (n=25); CABG and mitral valve repair, Group 3 (n=31); mitral and mitral and aortic valve and/or tricuspid valve repair. Preoperative ejection fraction was above 40%. Albumin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, gamma-glutamyl transpeptidase, total bilirubin levels were collected preoperatively and on postoperative day 1, 3 and 7. Aortic cross-clamp (ACC), cardiopulmonary bypass (CPB) times, right atrial pressure, blood transfusion, use of inotropic support and intraaortic balloon pump, complications were recorded.

Results:

Demographic data were similar between groups (p>0.05). However; ACC, CPB and right atrial pressures were different (p<0.001). The total bilirubin values on preoperative, postoperative first, third and seventh days were higher in Group 3 in comparison with Group 1 and 2 (p<0.001). Other than incidence of ventricular arrhythmia (p=0.04), complications and mortalities were similar (p>0.05). The incidence of hyperbilirubinemia postoperatively in the first 7 days was 0% in Group 1, 4 patients (16%) in Group 2 and 5 patients (9.8%) in Group 3 (p=0.04). There was a correlation between preoperative total bilirubin levels and operation type, two valve operation and combined coronary and valvular operations (r=0.49 p=0.0001, r=0.43 p=0.0001, r=0.57, p=0.0001, respectively). Postoperative 1st and 3rd total bilirubin levels correlate to mortality, development of postoperative complications of pneumonia and renal failure and perioperative blood transfusion (p=0.0001).

Conclusion:

During open heart surgery, the total bilirubin levels in the first postoperative week correlates with perioperative blood transfusion and this causes an increased rate of complications and mortality in patients undergoing combined coronary and valvular surgeries or multiple valve surgeries.

Keywords: Hepatobiliary system, cardiopulmonary bypass, valvular repair surgery, coronary artery bypass graft surgery