演題

IS-1-3

The impact of liver fibrosis on early outcome in cardiovascular surgery

[演者] 樫山 紀幸:1
[著者] 戸田 宏一:1, 仲村 輝也:1, 宮川 繁:1, 吉川 泰司:1, 福嶌 五月:1, 吉岡 大輔:1, 斎藤 哲也:1, 上野 高義:1, 倉谷 徹:1, 澤 芳樹:1
1:大阪大学心臓血管外科

Background: The results of cardiovascular surgery (CVS) in liver cirrhosis (LC) are poor. It is important to evaluate preoperative risks of surgery in such cases, however it is difficult to diagnose LC exactly in high-risk cases for liver biopsy. In this study, we evaluated preoperative LF and investigated the impact of liver fibrosis (LF) on early outcome in CVS. Methods: From 1998 to 2014, 54 patients with LC underwent CVS. Preoperative risks were evaluated by JapanSCORE and EuroSCORE II. The relationship of APRI(=(AST/the upper limit of normal of AST)100/platelets counts) correlated with LC and hospital death was analyzed.Results: Mean follow-up duration was 34 months. Patients were classified in Child-pugh A, B and C in 30, 21 and 3 patients, respectively. LC caused by viral infection in 32 patients (59%). Surgical procedures included coronary artery bypass grafting in 14, valve surgery in 38, aortic surgery in 1 patient. Mean survival at 5 years was 70% and hospital death was 16.7%(9 patients). The causes of hospital death were gastrointestinal bleeding in 5, sepsis in 2, liver dysfunction in 1, and unknown in 1 patient. In pre- and intraoperative factors, APRI, cardiopulmonaly bypass (CPB) time and MELD score were significant risk factors by monovariate analysis, however, APRI(p=0.02) and CPB time (p=0.03) were only significant risk factors by multivariate analysis.Conclusion: In CVS for LC, CPB time and APRI correlated with LF were significant risk factors of hospital death, suggesting that less invasive surgery and evaluation of LF are important.
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