The results of this study appear in the July 2007 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantion.
In abdominal surgery, it is well known that the severity of liver cirrhosis, as measured by the Child-Pugh classification (a scoring system used to gauge the severity of liver disease) correlates directly with surgical outcome. However, few studies have reported how these patients fare when undergoing cardiac surgery.
Led by Farzan Filsoufi, of Mt. Sinai Hospital in New York, NY, researchers conducted a retrospective study of patients who underwent cardiac surgery at Mt. Sinai Medical Center between January 1998 and December 2004, and identified 27 patients who had cirrhosis. Of these, 18 patients had cardiac surgery with cardiopulmonary bypass (heart-lung machine) while the other 9 had surgery without using the heart-lung machine.
The results showed that hospital mortality increased significantly according to the Child-Pugh classification, with a mortality rate of 10 percent for those with class A, 18 percent for those with class B, and 67 percent for those with class C. Postoperative complications were also higher in class B and C than in class A. There was no correlation between mortality and the MELD (Model for End-Stage Liver Disease) score, however. Early studies reported a higher mortality for class B and C patients than seen in this study, but more recent studies have shown an improvement in survival rates. The current study confirms lower mortality for class B patients, which is probably due to improvements in surgical techniques and the management of cardiac surgery patients. In addition, there was no mortality for those who had coronary artery bypass surgery off-pump (without the heart-lung machine).
The authors note that alternative treatment strategies are needed for patients with advanced cirrhosis and cardiovascular diseases that require surgery. One potential approach is a combined liver transplant and cardiac operation, and there have been a few positive reports documenting such cases. “Despite early promising results with this combined approach the number of publications remains very limited and further investigations are required to determine the role of this treatment strategy in the armamentarium of cardiac and transplantation surgeons,” the authors state. Although hospital mortality decreased in this study, the rates of postoperative complications in class B and C were 55 percent and 100 percent respectively. Surgical trauma and the deleterious effects of cardiopulmonary bypass may explain the increased rate of complications, according to the authors.
The authors conclude that “cardiac surgery can be performed with low operative mortality and good mid-term survival in patients with Child-Pugh class A.” Acceptable results are also possible with class B patients, especially those who do not have surgery using the heart-lung machine, while for class C patients, who have cardiac surgery because of a life threatening condition, operative mortality remains high. The authors conclude: “Careful selection is critical in order to improve surgical outcome in patients with liver cirrhosis.”
In an accompanying editorial in the same issue, Gonzalo Gonzalez-Stawinski, of Cleveland Clinic in Cleveland, OH, notes that cirrhotic patients requiring open heart surgery are among the most challenging and complex patients seen in cardiac surgery. The author notes that the current study raises the question of whether elective cardiac interventions should be offered to patients with advanced cirrhosis, in the hopes of improving their survival and quality of life. He states that “caution needs to be exercised when taking on cirrhotic patients as data provided by Filsoufi, et. al would suggest that most patients with either Childs-Pugh B or C do not gain a survival advantage by correcting their cardiac pathology.” As an alternative, he suggests delaying and medically managing their heart disease in the hopes that they can undergo combined cardiac surgery and liver transplant, although not all patients would want or be eligible for such a solution and only a handful of centers in the U.S. have the capabilities to undertake it. He concludes, “Despite the challenges linked to the cirrhotic cardiac surgery patient, cardiac surgeons and hepatologists/liver transplant specialists need to continue to work in unison in hopes of improving the outcomes associated to this difficult patient population.”
Amy Molnar | EurekAlert!
WAKE-UP provides new treatment option for stroke patients | International study led by UKE
17.05.2018 | Universitätsklinikum Hamburg-Eppendorf
First form of therapy for childhood dementia CLN2 developed
25.04.2018 | Universitätsklinikum Hamburg-Eppendorf
The more electronics steer, accelerate and brake cars, the more important it is to protect them against cyber-attacks. That is why 15 partners from industry and academia will work together over the next three years on new approaches to IT security in self-driving cars. The joint project goes by the name Security For Connected, Autonomous Cars (SecForCARs) and has funding of €7.2 million from the German Federal Ministry of Education and Research. Infineon is leading the project.
Vehicles already offer diverse communication interfaces and more and more automated functions, such as distance and lane-keeping assist systems. At the same...
A research team led by physicists at the Technical University of Munich (TUM) has developed molecular nanoswitches that can be toggled between two structurally different states using an applied voltage. They can serve as the basis for a pioneering class of devices that could replace silicon-based components with organic molecules.
The development of new electronic technologies drives the incessant reduction of functional component sizes. In the context of an international collaborative...
At the LASYS 2018, from June 5th to 7th, the Laser Zentrum Hannover e.V. (LZH) will be showcasing processes for the laser material processing of tomorrow in hall 4 at stand 4E75. With blown bomb shells the LZH will present first results of a research project on civil security.
At this year's LASYS, the LZH will exhibit light-based processes such as cutting, welding, ablation and structuring as well as additive manufacturing for...
There are videos on the internet that can make one marvel at technology. For example, a smartphone is casually bent around the arm or a thin-film display is rolled in all directions and with almost every diameter. From the user's point of view, this looks fantastic. From a professional point of view, however, the question arises: Is that already possible?
At Display Week 2018, scientists from the Fraunhofer Institute for Applied Polymer Research IAP will be demonstrating today’s technological possibilities and...
So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics
Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...
25.05.2018 | Event News
02.05.2018 | Event News
13.04.2018 | Event News
25.05.2018 | Event News
25.05.2018 | Machine Engineering
25.05.2018 | Life Sciences