E-ISSN: 2667-6370
The Investigation of Occurrence of Hepatic Dysfunction in the Postoperative Period of Open-Heart Surgery
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Original Article
VOLUME: 40 ISSUE: 6
P: 297-302
December 2012

The Investigation of Occurrence of Hepatic Dysfunction in the Postoperative Period of Open-Heart Surgery

Turk J Anaesthesiol Reanim 2012;40(6):297-302
DOI: 10.5152/TJAR.2012.010
İsmail Özkaynak 1
Ayşe Baysal 1
Mevlüt Doğukan 2
Ömer Şavluk 3
Buket Özyaprak 1
Sabiye Akbulut 4
Tuncer Koçak 1
1. Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye
2. Adıyaman Üniversitesi Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Adıyaman, Türkiye
3. Yahyalı Devlet Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Kayseri, Türkiye
4. Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Gastroenteroloji Kliniği, İstanbul, Türkiye
No information available.
No information available
Received Date: 03.11.2011
Accepted Date: 16.04.2012
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ABSTRACT

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

References

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