Cardiac Surgery in Patients With Liver Cirrhosis (CASTER) Study: Early and Long-Term Outcomes
| Autor: | Francesca Nicolò, Marco Picichè, Davide Pacini, Andrea Garatti, Loris Salvador, Giovanni Troise, Antonio Salsano, Lorenzo Menicanti, Marzia Cottini, Guglielmo Mario Actis Dato, Roberto Scrofani, Elisa Mikus, Alessandro Parolari, Claudio Russo, Margherita Dalla Tomba, Luca Di Marco, Francesco Santini, Andrea Daprati, Paolo Centofanti, Giorgios Kounakis, Alberto Albertini, Domenico Paparella |
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| Přispěvatelé: | Garatti, Andrea, Daprati, Andrea, Cottini, Marzia, Russo, Claudio F, Dalla Tomba, Margherita, Troise, Giovanni, Salsano, Antonio, Santini, Francesco, Scrofani, Roberto, Nicolò, Francesca, Mikus, Elisa, Albertini, Alberto, Di Marco, Luca, Pacini, Davide, Picichè, Marco, Salvador, Lori, Actis Dato, Guglielmo M, Centofanti, Paolo, Paparella, Domenico, Kounakis, Giorgio, Parolari, Alessandro, Menicanti, Lorenzo |
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Liver Cirrhosis Male medicine.medical_specialty Cirrhosis Time Factors Heart Diseases Population Comorbidity 030204 cardiovascular system & hematology Gastroenterology Risk Assessment Severity of Illness Index 03 medical and health sciences Liver disease 0302 clinical medicine Esophageal varices Postoperative Complications Risk Factors Internal medicine Ascites medicine Humans Cardiac Surgical Procedures education Aged Retrospective Studies education.field_of_study business.industry EuroSCORE Retrospective cohort study Perioperative medicine.disease Survival Rate Treatment Outcome 030228 respiratory system Italy Surgery Female Liver Cirrhosis cardiac surgery ( medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of thoracic surgery. 111(4) |
| ISSN: | 1552-6259 |
| Popis: | BACKGROUND: Patients with liver cirrhosis (LC) undergoing cardiac surgery (CS) face perioperative high mortality and morbidity, but extensive studies on this topic are lacking.METHODS: All adult patients with LC undergoing a CS procedure between 2000 and 2017 at 10 Italian Institutions were included in this retrospective cohort study. LC was classified according to preoperative Child-Turcotte-Pugh (CTP) score and Model for End-Stage Liver Disease (MELD) score. Early-term and medium-term outcomes analysis was performed in the overall population and according to CTP classes.RESULTS: The study population included 144 patients (mean age 66 ± 9 years, 69% male). Ninety-eight, 20, and 26 patients were in CTP class A, in early CTP class B (MELD score 12), respectively. The main LC etiologies were viral (43%) and alcoholic (36%). Liver-related clinical presentation (ascites, esophageal varices, and encephalopathy) and laboratory values (estimated glomerular filtration rate, serum albumin, and bilirubin, platelet count) significantly worsened across the CTP classes (P= .001). Coronary artery bypass grafting or valve surgery (87% bioprosthesis) were performed in 36% and 50%, respectively. Postoperative complications (especially acute kidney injury, liver complication, and length of stay) significantly worsened in advanced CTP class B (P= .001). Notably, observed mortality was 3-fold or 4-fold higher than the EuroSCORE (European System for Cardiac Operative Risk Evaluation) II-predicted mortality, in the overall population, and in the subgroups. At Kaplan-Meier analysis, 1-year and 5-year cumulative survival in the overall population was 82% ± 3% and 77% ± 4%, respectively. The 5-year survival in CTP class A, early CTP class B, and advanced CTP class B was 72% ± 5%, 68% ± 11%, and 61% ± 10%, respectively (P= .238).CONCLUSIONS: CS outcomes in patients with LC are significantly affected in relation to the extent of preoperative liver dysfunction, but in early CTP classes, medium-term survival is acceptable. Further analysis are needed to better estimate the preoperative risk stratification of these patients. |
| Databáze: | OpenAIRE |
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