Outcomes in cardiac surgery patients with advanced liver disease

Abstract

Objective: This study seeks to evaluate whether the presence of advanced liver disease is associated with worse cardiac surgical outcomes.Methods: This is a single-center retrospective observational study including 285 patients who underwent cardiac surgery at Yale New Haven Hospital (YNHH) from 2010 to 2020. The study cohort was stratified into three groups, CTP class A (n = 219), CTP early class B (n = 34), and CTP advanced class B (n = 32). A receiver-operating characteristic (ROC) curve analysis on 30-day mortality was used to determine the cutoff point of the MELD score (12.7) used to dichotomize CTP class B into early and advanced groups. Univariable and multivariable logistic regression analysis was performed to identify variables affecting 30-day mortality. Statistical tests were significant when the p-value <0.05 and the confidence interval (CI) was 95%.Results: Patients in CTP advanced class B had the longest hospital length of stay (LOS) (14 days), the highest rate of prolonged ventilation (46.9%), renal failure (21.9%), and death at 30-day (18.8%) as well as death at discharge (18.8%). When looking at a composite outcome of categorical post-operative complications (excl. mortality status), 59.4% of patients in CTP advanced class B had at least one postoperative complication, whereas patients in CTP class A (37.9%) and CTP early class B (38.2%) had a similar incidence rate. Multivariable logistic regression analysis demonstrated that female gender (OR: 3.01, 95% CI: 1.07 – 8.77, p = 0.037) and peripheral vascular disease (OR: 4.01, 95% CI: 1.33 – 12.2, p = 0.013) were independent predictors of 30-day mortality in patients with advanced liver disease.Conclusions: Increasing severity of preoperative liver disease has a significant effect on perioperative outcomes in cardiac surgery. Our data suggests that select patients in CTP class A, as well as patients in CTP class B with a MELD score of <12.7 that have undergone a careful risk/benefit evaluation may be able to undergo cardiac surgery without a severe increase in risk of mortality. Further research is however needed to confirm these findings.